急診之初始血糖值是梗塞性中風後病人功能之預後因子

Initial Blood Glucose Level in the Emergency Department as a Prognostic Factor on Functional Outcome of Ischemic Stroke

陳儀敏(Yi-Min Chen) ； 胡國琦(Gwo-Chi Hu) ； 陳建鵬(Jiann-Perng Chen) ； 陳建森(Chien-Shen Chen) ； 廖正宗(Cheng-Tsong Liao) ； 陳冠文(Kuan-Wen Chen)

《台灣復健醫學雜誌》 36卷2期 (2008/06) Pp. 89-95

https://doi.org/10.6315/2008.36(2)03

摘要

雖然目前已有許多研究針對病人腦中風後的功能恢復的預後因子加以研究，但很少研究針對急診的初始血糖值來評估腦中風後的病人經過復健治療後的功能預後，因爲急診的初始血糖值可以代表腦中風後的急性反應、也不會受到在急診室一些醫療處置所影響，本研究的主要目的爲評估急診的初始血糖值對腦中風的病人經復健治療後其功能預後的角色。
本研究共收集221位因爲首次腦中風造成功能障礙而照會復健科醫師並接受復健治療的病人，排除復發性及出血性中風的病人，和在復健治療過程中因爲內科問題而中斷復健治療者。病患的基本資料和相關變項資料由病歷回顧得到，結果評估爲經復健治療一個月後的巴氏量表和改良式Rankin scale分數，急診的初始血糖值≧140 mg/dL定義爲高血糖組。針對初始血糖值和其他重要變項值用邏輯迴歸分析和日常生活功能和殘障程度進行多變項分析。
在221個研究對象中，113位是男性、108位是女性，平均年齡爲65.8±12.38歲。在調整年紀、中風嚴重程度等因素後，急診血糖值≧140 mg/dL仍然是日常生活功能不好（危險對比值：4.64；95%信賴區間：2.355-9.137）和嚴重殘障程度（危險對比值：4.80；95%信賴區間：2.437-9.443）的獨立危險預測因子。
急診初始血糖值爲第一次中風後經復健治療功能恢復的重要、獨立的危險因子，面對急診血糖值大於140 mg/dl的病人，應該更積極的給予復健治療以促進功能恢復。

關鍵字

急診 ； 血糖值 ； 中風 ； 功能預後

並列摘要

Although many studies are available in focus on prognostic factors for acute cerebral vascular disease, there are few reports to discuss the impact of the initial glucose level on the functional outcome after stroke. The initial glucose level in the emergency department is more representative of acute glucose response after stroke and is not influenced by the treatment in the emergency department. The aim of our study is to evaluate the prognostic role of the initial glucose level on the functional outcome after stroke.
We recruited individuals who sustained first-ever stroke and were admitted to an inpatient stroke rehabilitation program. Patients with previous history of stroke, intra-cerebral hemorrhage, or rehabilitation programs were held due to medical problem were excluded. Hyperglycemia was defined as an initial glucose level≧140 mg/dL in emergency department. The medical record and related information were obtained by chart review. The Barthel index and the Modified Rankin Scale were used to assess the outcome 1 month later. Multiple logistic regression analyses were performed to identify factors associated with outcome measurements.
A total of 221 eligible patients (113 males and 108 females with a mean age 65.8±12.38 years) were recruited into the study. After adjusting for age and the scores of National Institute of Health Stroke Scale (NIHSS), higher initial glucose levels remained an independent predictor of poor functional outcome (odds ratio, 4.64; 95% confidence interval, 2.355-9.137) and greater degrees of disability (odds ratio, 4.80; 95% confidence interval, 2.437-9.443)
The initial blood glucose level in the emergency department is an important and independent factor for poor functional outcome after stroke. We should arrange early and constructive rehabilitation programs to accelerate the functional outcome for patients with an initial glucose level more than 140 mg/dL.

並列關鍵字

emergency department ； blood glucose level ； stroke ； functional outcome