急性脑血管病患者应激性高血糖、血清钾、钠、氯变化及其及中风.doc

急性脑血管病患者应激性高血糖、血清钾、钠、氯变化及其及中风 　 赵淑清，董加纯，李玲玲，刘爱霞，董加利 【摘要】 目的 探讨急性脑血管病患者应激性高血糖、血清钾、钠、氯的变化及其与中风类型、病情轻重、预后关系。方法 本文对我院神经内科2004年6月~2005年6月住院急性脑血管病患者248例进行研究，其中出血性中风89例，缺血性中风159例，于入院次日晨检测空腹血糖、血清钾、钠、氯，观察血糖、血钠、血氯、血钾值的变化及其与脑卒中类型、病情轻重、预后关系。结果 （1）急性脑血管病患者易出现应激性高血糖、低钠血症、低氯血症、低钾血症；（2）出血性中风血糖明显高于缺血性中风；高血糖组死亡率明显高于非高血糖组；死亡组的血糖均值亦显著高于存活组；统计学上差异有显著性。（3）出血性中风低血钠、低血氯的发生率明显高于缺血性中风，统计学上差异有显著性；低血钠、低血氯组中的中、重度患者显著多于正常血钠、血氯组；与正常血钠、血氯组相比，高血钠、高血氯组患者在中风类型、病情轻重及预后方面差异均无显著性，但血钠、血氯显著升高时，死亡率明显增加。与正常血钾组相比，低血钾组中患者在中风类型、病情及预后方面差异无显著性，但血钾明显降低时，病死率增加。高血钾组患者在中风类型、病情轻重和正常血钾组相比差异无显著性，但病死率则明显高于正常血钾组。结论 急性脑血管病患者存在应激反应，急性脑血管病患者应激性高血糖、低钠血症、低氯血症可以作为判断急性脑血管病病情、预后评估的指标之一。高钠血症、高氯血症、高钾血症、低钾血症与中风类型、病情及预后方面差异无显著性，但当出现严重的高钠血症、高氯血症、高钾血症、低钾血症时，病死率明显增加。 【关键词】 急性脑血管病；应激性高血糖；血清钾；血清钠；血清氯 【Abstract】 Objective To explore the relationship between irritable hyperglycemia and the change of serum potassium，serum natrium，serum chloremia on stroke type，developing degree of stroke type，developing of illness and prognosis in ACVD. Methods We detected 4 indexes in 248 patients who suffered from ACVD in one week in our hospital from Jun 2004. to Jun 2005，including 89 cases were intracerebral hemorrhage and 159 cases were cerebral ischemia. The detected items include the fasting blood-glucose and fasting serum Na+，K+，Cl- next morning. To observe the relationship between irritable hypernatrium，hyponatremia，hypernatrium，hypokalemia，hyperkalemia，hypochloremia and hyperchloremia on stroke type，developing of illness and prognosis in ACVD. Results （1）The results showed that patients who involved in ACVD constantly turned up hyperglycemia，hyponatremia，hypochloremia，hyperkalemia. （2）The increasing level of blood-glucose was apparent in intracerebral hemorrhage compared with cerebral ischemia. The death rate in hyperglycemia apparently increased. The fasting blood-glucose markedly increased in dead index compared with survival index. There are significantly difference.（3）Hyponatremia，hypochloremia were related with stroke type，developing of i