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【文摘发布】葡萄糖＋钾＋胰岛素治疗卒中后高
Author：Gray CS, Hildreth AJ, Sandercock PA, O'Connell JE, Johnston DE, Cartlidge NE, Bamford JM, James OF, Alberti KG; GIST Trialists Collaboration.
School of Clinical Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK. chris.gray@chs.northy.nhs.uk
Resource: Lancet Neurol. 2007 May;6(5):380-1.
Abstract：BACKGROUND: Hyperglycaemia after acute stroke is a common finding that has been associated with an increased risk of death. We sought to determine whether treatment with glucose-potassium-insulin (GKI) infusions to maintain euglycaemia immediately after the acute event reduces death at 90 days. METHODS: Patients presenting within 24 h of stroke onset and with admission plasma glucose concentration between 6.0-17.0 mmol/L were randomly assigned to receive variable-dose-insulin GKI (intervention) or saline (control) as a continuous intravenous infusion for 24 h. The purpose of GKI infusion was to maintain capillary glucose at 4-7 mmol/L, with no glucose intervention in the control group. The primary outcome was death at 90 days, and the secondary endpoint was avoidance of death or severe disability at 90 days. Additional planned analyses were done to determine any differences in residual disability or neurological and functional recovery. The trial was powered to detect a mortality difference of 6% (sample size 2355), with 83% power, at the 5% two-sided significance level. This study is registered as an International Standard Randomised Controlled Trial (number ISRCTN 31118803) FINDINGS: The trial was stopped due to slow enrolment after 933 patients were recruited. For the intention-to-treat data, there was no significant reduction in mortality at 90 days (GKI vs control: odds ratio 1.14, 95% CI 0.86-1.51, p=0.37). There were no significant differences for secondary outcomes. In the GKI group, overall mean plasma glucose and mean systolic blood pressure were significantly lower than in the control group (mean difference in glucose 0.57 mmol/L, p<0.001; mean difference in blood pressure 9.0 mmHg, p<0.0001). INTERPRETATION: GKI infusions significantly reduced plasma glucose concentrations and blood pressure. Treatment within the trial protocol was not associated with significant clinical benefit, although the study was underpowered and alternative results cannot be excluded.
PMID: 17434094
葡萄糖＋钾＋胰岛素除了可控制血糖，还有补液的作用，在神经科病房应用还是不少的（至少我这里是这样），这种治疗会对卒中的预后有影响吗？（好像理论上是有好处的） 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Title：Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK).
Author：Gray CS, Hildreth AJ, Sandercock PA, O'Connell JE, Johnston DE, Cartlidge NE, Bamford JM, James OF, Alberti KG; GIST Trialists Collaboration.
School of Clinical Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK. chris.gray@chs.northy.nhs.uk
Resource: Lancet Neurol. 2007 May;6(5):380-1.
题目：静脉滴注葡萄糖-氯化氯化钾-胰岛素与卒中后高血糖护理：英国葡萄糖-胰岛素治疗中风试验
作者：
来源：柳叶刀，2007年5月第六卷第五期，380-381页
Abstract：BACKGROUND: Hyperglycaemia after acute stroke is a common finding that has been associated with an increased risk of death. We sought to determine whether treatment with glucose-potassium-insulin (GKI) infusions to maintain euglycaemia immediately after the acute event reduces death at 90 days.
摘要：
背景：急性卒中后常见有高血糖，它与死亡风险上升有密切联系。我们采用静脉滴注葡萄糖-氯化钾-胰岛素（GKI）维持急性事件之后的血糖恒定，观察该治疗是否可以降低第90天时的死亡率。
METHODS: Patients presenting within 24 h of stroke onset and with admission plasma glucose concentration between 6.0-17.0 mmol/L were randomly assigned to receive variable-dose-insulin GKI (intervention) or saline (control) as a continuous intravenous infusion for 24 h. The purpose of GKI infusion was to maintain capillary glucose at 4-7 mmol/L, with no glucose intervention in the control group. The primary outcome was death at 90 days, and the secondary endpoint was avoidance of death or severe disability at 90 days. Additional planned analyses were done to determine any differences in residual disability or neurological and functional recovery. The trial was powered to detect a mortality difference of 6% (sample size 2355), with 83% power, at the 5% two-sided significance level. This study is registered as an International Standard Randomised Controlled Trial (number ISRCTN 31118803)
方法：随机挑选卒中发作24小时内收治的患者，入院时血糖浓度介于6.0-17.0mmol/L之间。患者给予静脉滴注各种不同剂量的胰岛素GKI（治疗组）或生理盐水（对照组），持续时间为24小时。GKI静脉滴注的目的在于将微血管血糖维持在4-7mmol/L之间，对照组未给予葡萄糖治疗。第90天时主要疗效指标为死亡，次要终点为在第90天时避免死亡或严重残疾。采用附加计划分析确定残疾症状、神经或功能改善方面的差异。这项试验按检验效能计算得出死亡率差异为6%（取样数2355例）；按5%的显著水平进行双侧检验时，检验效能为83%。这项研究加入了随机对照试验国际标准（登记号 ISRCTN 31118803）。
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作者:admin@医学,生命科学 2011-05-01 17:11
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