Du Lin-Zhe, Liu Pei-Yan, Ge Chen-Yan, Li Yang, Li Yuan-Yuan, Tang Mu-Fei, Chen Jin-Jin
Department of Clinical Pharmacy, Nanjing First Hospital, Nanjing, People's Republic of China.
Neuropsychiatr Dis Treat. 2022 Jul 1;18:1309-1314. doi: 10.2147/NDT.S370776. eCollection 2022.
Continuous intravenous infusion (IV) or subcutaneous injection (SC) of insulin was widely applied to control hyperglycemia after ischemic stroke. However, the impact of different administration modes on glycemic variability was unknown.
Consecutive stroke patients treated with intravenous thrombolysis were screened. Subjects who received insulin treatment were included and entered into the IV or SC group according to the respective administration mode. Blood glucose was closely monitored within the first 72 hours, and the target range of glucose was from 7.7 to 10.0 mmol/L for all patients. The variabilities of glucose, assessed using standard deviation of the mean, variable coefficient and range from the maximum to the minimum value, were compared between the two groups.
A total of 130 patients were enrolled with 66 in the IV groups and 64 in the SC group. Compared with the SC group, the IV group had higher glycemic variability evaluated as either standard deviation (2.7 ± 0.7 mmol/L vs 2.2 ± 0.9 mmol/L, p = 0.002), variable coefficient (0.26 ± 0.06 vs 0.23 ± 0.08, p = 0.011) or range (10.0 ± 3.6 mmol/L vs 8.1 ± 3.1 mmol/L, p = 0.001). Multivariate logistic regression analyses found that continuous intravenous infusion was associated with higher level of the standard deviation (adjusted OR 3.01, 95% CI 1.29-7.28, p = 0.011), variable coefficient (adjusted OR 5.97, 95% CI 2.55-13.96, p < 0.001) and range (adjusted OR 6.08, 95% CI 2.63-14.05, p < 0.001).
Continuous intravenous infusion of insulin was associated with higher glycemic variability than subcutaneous injection in acute stroke patients receiving thrombolysis.
持续静脉输注胰岛素或皮下注射胰岛素被广泛应用于控制缺血性卒中后的高血糖。然而，不同给药方式对血糖变异性的影响尚不清楚。
筛选接受静脉溶栓治疗的连续卒中患者。纳入接受胰岛素治疗的受试者，并根据各自的给药方式分为静脉输注组或皮下注射组。在最初72小时内密切监测血糖，所有患者的血糖目标范围为7.7至10.0 mmol/L。比较两组间使用平均标准差、变异系数和最大值到最小值范围评估的血糖变异性。
共纳入130例患者，静脉输注组66例，皮下注射组64例。与皮下注射组相比，静脉输注组的血糖变异性更高，以标准差（2.7±0.7 mmol/L对2.2±0.9 mmol/L，p = 0.002）、变异系数（0.26±0.06对0.23±0.08，p = 0.011）或范围（10.0±3.6 mmol/L对8.1±3.1 mmol/L，p = 0.001）评估。多因素逻辑回归分析发现，持续静脉输注与更高水平的标准差（调整后的比值比3.01，95%置信区间1.29 - 7.28，p = 0.011）、变异系数（调整后的比值比5.97，95%置信区间2.55 - 13.96，p < 0.001）和范围（调整后的比值比6.08，95%置信区间2.63 - 14.05，p < 0.001）相关。
在接受溶栓治疗的急性卒中患者中，持续静脉输注胰岛素比皮下注射胰岛素具有更高的血糖变异性。
