The Effect Of Modified And Intensified Insulin Therapy On The Prognosis Of Patients With Stroke

Objective Stress hyperglycemia is a common complication in patients with stroke,and the control level of blood glucose is related to the clinical neurological function recovery of patients.The aim of this study is to investigate the the relationship between hyperglycemia level and the prognosis of patients with stroke and the clinical prognosis of patients.Methods Prospective randomized clinical trial methods were used.From January 2015 to December 2017,stroke patients hospitalized in the affiliated hospital to Qingdao university were studied.Patients eligible for inclusion were randomly divided into modified insulin intensive group and routine insulin intensive group.The target of blood glucose control in the improved and strengthened insulin group was 7.0-9.0 mmol/L.The blood glucose control objective of the routine intensive insulin group was 4.4-6.1mmol/L.The incidence of hypoglycemia,insulin pumping time,artificial airway establishment rate,pulmonary infection rate,serum albumin metabolism,hospitalization time and clinical prognosis were compared between the two groups.The neurological function of the patients was evaluated by neurological function defect score.Glasgow prognostic score was used to evaluate the clinical prognosis of patients at discharge.Results A total of 783 patients were included in the data analysis.28 cases were lost to the improved insulin group,and 394 cases were included in the data analysis.Thirty-two patients in the routine intensive insulin group were lost to follow-up,and 389 cases were included in the data analysis.There were 115 cases of hypoglycemia,accounting for14.69%.The lowest blood glucose level was 1.64mmol/L.The incidence of hypoglycemia in the routine group was significantly higher than that in the modified group(P <0.01).The infusion time of insulin in the two groups was 7.75± 2.73 days,6.36± 2.44 days in the improved group and 8.17± 2.91 days in the conventional group.The infusion time of insulin in the improved group was lower than that in the conventional group(P <0.01).The total amount of insulin pumped in the two groups was 867.87± 113.28 U,784.92± 105.69 U in the improved intensive insulin treatment group,921.63± 146.77 U in the conventional intensive insulin treatment group,and the total amount of insulin pumped in the improved group was lower than that in the conventional group(P <0.01).The establishment of artificial airway in the improved insulin intensive group was lower than that in the conventional insulin intensive group(P < 0.05).The number of death cases in the modified group was less than that in the conventional group,and the difference was statistically significant(P < 0.05).On the 7th day of hospitalization,the NIHSS score of the modified group was lower than that of the conventional group(P <0.01).The GOS score of patients in the modified group at 3 months after discharge which was better than that in the conventional group(3.47±1.22 VS 3.31±1.13,P<0.05).Conclusion Stress hyperglycemia is a common complication in stroke patients.The application of insulin to control hyperglycemia is the first choice for the treatment of stress hyperglycemia.Compared with 4.4-6.1mmol/L,controlling blood glucose to7.0-9.0mmol/L can significantly reduce the incidence of blood glucose,protect the function of central nervous system,and improve the course of disease and clinical prognosis of patients.The mechanism of blood glucose control at 7.0-9.0mmol/L to improve the function of central nervous system in addition to avoiding hypoglycemia,whether there is a neuroprotective effect of permissive hyperglycemia remains to be confirmed by further clinical and basic studies.