Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke
Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke
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水合作用可防止慢性高血糖患者缺血性中风后神经功能恶化
DOI：
10.1111/ane.12900
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Zhao J
中科院分区：
文献类型：
--
作者：
Lin J;Weng Y;Li m;Mo Y;Zhao J
目的探讨慢性高血糖是否使患者易发生脱水，从而促进神经功能恶化，并探讨控制脱水是否能改善功能预后。患者与方法本研究纳入355例满足血糖间隙≤0的急性缺血性脑卒中合并糖尿病住院患者。我们使用了以下截断值：(i)无慢性高血糖（糖化血红蛋白A1c [HbA1c] < 7%）和（ii）慢性高血糖（HbA1c≥7%）。慢性高血糖患者随机分为对照组和水合治疗组。水合治疗仅在水合组开始。以血尿素氮(BUN)/肌酐（Cr）比值作为脱水指标。采用美国国立卫生研究院卒中量表（NIHSS）评估入院和出院时卒中严重程度。结果对照组和水合组的基线BUN/Cr平均值均高于无慢性高血糖组。平均BUN/Cr比值由第1天的91.22±29.95降至第3天的77.03±18.23 （P< 0.001）。入院后第3天，补水组BUN/Cr与无慢性高血糖组比较，差异无统计学意义（P=.831）。神经功能恶化以对照组最高（33.6%,36/107），其次为水合组（10.5%,11/105）和无慢性高血糖组（5.6%,8/143）。结论排除应激性高血糖的影响后，慢性高血糖与入院NIHSS评分及神经功能恶化有关。此外，水合疗法可能有助于防止神经退化。
ObjectivesTo determine whether chronic hyperglycaemia predisposes patients to dehydration, which may promote neurological deterioration, and to investigate whether dehydration control improves functional outcome.Patients and MethodsThis study included 355 patients hospitalized with acute ischaemic stroke and diabetes mellitus who fulfilled the glycaemic gap ≤0. We used the following cut‐offs: (i) no chronic hyperglycaemia (glycated haemoglobin A1c [HbA1c] < 7%) and (ii) chronic hyperglycaemia (HbA1c ≥ 7%). The chronic hyperglycaemic patients were randomly divided into the control group and the hydration group. Hydration therapy was only initiated in the hydration group. The blood urea nitrogen (BUN)/creatinine (Cr) ratio was used as an indicator of dehydration. Stroke severity on admission and discharge was assessed by means of National Institutes of Health Stroke Scale (NIHSS).ResultsThe mean baseline BUN/Cr ratios were higher in the control group and hydration group than in the no chronic hyperglycaemia group. The mean BUN/Cr ratio decreased from 91.22 ± 29.95 on the first day to 77.03 ± 18.23 on the third day (P<.001) in the hydration group. On the third day after admission, there was no significant difference in the BUN/Cr ratio between the hydration group and the no chronic hyperglycaemia group (P=.831). Moreover, neurological deterioration was highest in the control group (33.6%, 36/107), followed by the hydration group (10.5%, 11/105) and the no chronic hyperglycaemia group (5.6%, 8/143).ConclusionsChronic hyperglycaemia was associated with the admission NIHSS score and neurological deterioration after excluding the effect of stress hyperglycaemia. Furthermore, hydration therapy may help prevent neurological deterioration.