Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Comput Math Methods Med. 2022 Aug 29;2022:8553539. doi: 10.1155/2022/8553539. eCollection 2022.
Cerebral hemorrhage, also known as hemorrhagic stroke, is a common clinical cerebrovascular disease, accounting for about 10%-30% of stroke, with high morbidity and mortality.
To observe the effect of optimal management of hyperglycemia and intensive nursing on blood glucose control level and complications in patients with postoperative cerebral hemorrhage.
One hundred and eight patients with postoperative cerebral hemorrhage comorbid with stress hyperglycemia admitted to our neurosurgery department from February 2019 to February 2022 were selected and divided into a general group of 54 cases and an optimized group of 54 cases by simple random method. The general group was managed with conventional care, while the optimized group developed optimized management of hyperglycemia for intensive care. The indexes related to blood glucose control, electrolytes, National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI) scores, and time to achieve blood glucose standard, insulin pumping time, patient satisfaction, and prognosis were compared between the two groups.
Before intervention, there was no statistical significance in the comparison of blood glucose control-related indicators and electrolytes between the two groups ( > 0.05). After 7 d and 14 d of intervention, the fasting blood glucose and 2 h postprandial blood glucose in the two groups were lower than before, while K+ and Na+ were higher than before ( < 0.05). The blood glucose indexes at the same time point in the optimized group were found to be lower than those in the general group by statistical analysis, but electrolytes were not statistically significant when compared with the general group ( > 0.05). In the optimized group, the time to achieve blood glucose standard (6.59 ± 1.94) d and insulin pumping time (7.14 ± 1.89) d were shorter than those in the general group [(7.48 ± 2.12) d and (8.58 ± 2.14) d], insulin dosage (748.85 ± 63.61) U was less than that in the general group (923.54 ± 84.14) U, and the incidence of hypoglycemia (3.70%) was lower than that in the general group (16.67%), and the satisfaction rate (92.59%) was higher than that of the general group (77.78%), which was statistically significant ( < 0.05). Before intervention, there was no significant difference in NIHSS score and BI score between the two groups ( > 0.05). After 7 d and 14 d of intervention, the NIHSS scores of the two groups were lower than before, while the BI scores were higher than before, and the NIHSS scores of the optimized group at the same time point were all lower than those of the general group, and the BI scores were higher than those of the general group ( < 0.05). The incidence of pulmonary infection (11.11%) and rebleeding (7.41%) in the optimized group were lower than those in the general group (25.93% and 22.22%), while deep vein thrombosis, multiple organ dysfunction syndrome (MODS), and death within 28 d was not statistically significant when compared with the general group ( > 0.05).
Optimal management of hyperglycemia and intensive nursing can effectively control the blood sugar level of patients after cerebral hemorrhage, reducing insulin dosage, and the occurrence of hypoglycemia, pulmonary infection, and rebleeding.
脑出血又称出血性脑卒中，是一种常见的临床脑血管病，约占脑卒中的 10%-30%，具有较高的发病率和死亡率。
观察强化血糖管理和强化护理对脑出血术后患者血糖控制水平及并发症的影响。
选取 2019 年 2 月至 2022 年 2 月我院神经外科收治的 108 例并发应激性高血糖的脑出血术后患者，采用简单随机方法分为常规组 54 例和优化组 54 例。常规组给予常规护理，优化组采用强化血糖管理的优化护理。比较两组患者的血糖控制相关指标、电解质、美国国立卫生研究院卒中量表（NIHSS）评分、巴氏指数（BI）评分、血糖达标时间、胰岛素泵入时间、患者满意度和预后。
干预前，两组血糖控制相关指标和电解质比较差异无统计学意义（>0.05）。干预后 7、14 d，两组空腹血糖和餐后 2 h 血糖均低于干预前，而 K+和 Na+均高于干预前（<0.05）。经统计学分析，优化组同时间点的血糖指标低于常规组，但电解质比较差异无统计学意义（>0.05）。优化组血糖达标时间（6.59±1.94）d 和胰岛素泵入时间（7.14±1.89）d 短于常规组[（7.48±2.12）d 和（8.58±2.14）d]，胰岛素用量（748.85±63.61）U 少于常规组[（923.54±84.14）U]，低血糖发生率（3.70%）低于常规组（16.67%），患者满意度（92.59%）高于常规组（77.78%），差异均有统计学意义（<0.05）。干预前，两组 NIHSS 评分和 BI 评分比较差异无统计学意义（>0.05）。干预后 7、14 d，两组 NIHSS 评分均低于干预前，BI 评分均高于干预前，且优化组同时间点 NIHSS 评分均低于常规组，BI 评分均高于常规组（<0.05）。优化组肺部感染（11.11%）和再出血（7.41%）的发生率低于常规组（25.93%和 22.22%），但深静脉血栓形成、多器官功能障碍综合征（MODS）和 28 d 内死亡率与常规组比较差异无统计学意义（>0.05）。
强化血糖管理和强化护理可有效控制脑出血术后患者的血糖水平，减少胰岛素用量，降低低血糖、肺部感染和再出血的发生。
