缺血性脑卒中患者高血糖管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2023.02.017

摘要/Abstract

摘要： 目的检索并总结国内外缺血性脑卒中患者高血糖管理的最佳证据,为制订科学合理的高血糖管理方案提供参考。方法采用PIPOST模式构建循证问题,系统检索PubMed、Web of Science、Cochrane Library、UpToDate、BMJ Best Practice、国际指南网、加拿大安大略注册护士协会、英国国家临床医学研究所指南库、苏格兰院际指南网、美国内科医师协会、中国知网、万方数据库、医脉通中有关缺血性脑卒中患者高血糖管理的指南、最佳临床实践信息手册、证据总结、专家共识、系统评价及标准,检索时限为建库至2022年11月,由2名研究者对纳入文献质量进行独立评价,提取相关证据。结果共纳入12篇文献,包括指南7篇、系统评价2篇、专家共识2篇、证据总结1篇,总结26条最佳证据,包括入院评估与处理、院内血糖监测与管理、血糖控制目标、出院指导、非药物干预、药物干预6个方面。结论该研究总结了缺血性脑卒中患者高血糖管理的最佳证据,可为临床医护人员临床实践提供参考。

关键词: 缺血性卒中, 高血糖症, 证据总结, 循证护理学

Abstract: Objective To summarize the best evidence of hyperglycemia management in ischemic stroke patients for formulating a scientific and reasonable hyperglycemia management scheme. Methods According PIPOST model to construct evidence-based questions, we systematically searched PubMed, Web of Science,Cochrane Library, UpToDate,BMJ Best Practice, GIN, RANO, NICE, SIGN, ACP, CNKI, Wanfang Data,Medlive.cn on the evidence related to hyperglycemia management in ischemic stroke patients,including guidelines,best clinical practice information manuals,evidence summaries,expert consensuses,systematic reviews,and standards. The search time limit was from the establishment of databases to November 2022. Two trained researchers evaluated the quality of the literature,and extracted the evidence. Results A total of 12 articles were included,including 7 guidelines,2 systematic reviews,2 expert consensuses,1 evidence summary. The best evidence included 26 recommendations in 6 aspects,namely admission assessment and management,in-hospital blood glucose monitoring and management,goals of blood glucose control,discharge guidance,non-pharmacological intervention and pharmacological intervention. Conclusion This study summarized the best evidence of hyperglycemia glucose management in ischemic stroke patients,and provided evidence-based references for clinical practice of clinical medical staff.

Key words: Ischemic Stroke, Hyperglycemia, Evidence Summary, Evidence-Based Nursing

廖宗峰, 易巧利, 毛李烨, 李玲. 缺血性脑卒中患者高血糖管理的最佳证据总结[J]. 中华急危重症护理杂志, 2023, 4(2): 172-178.

LIAO Zongfeng, YI Qiaoli, MAO Liye, LI Ling. Summary of best evidence for hyperglycemia management in patients with ischemic stroke[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(2): 172-178.

参考文献

[1] 王拥军,李子孝,谷鸿秋,等. 中国卒中报告2019(中文版)(1)[J]. 中国卒中杂志,2020,15(10):1037-1043.
Wang YJ,Li ZX,Gu HQ,et al.China stroke statistics 2019(1)[J]. Chin J Stroke,2020,15(10):1037-1043.
[2] Johnston KC,Bruno A,Pauls Q,et al.Intensive vs standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke:the SHINE randomized clinical trial[J]. JAMA,2019,322(4):326-335.
[3] Cui QY,Naikoo NA.Modifiable and non-modifiable risk factors in ischemic stroke:a meta-analysis[J]. Afr Health Sci,2019,19(2):2121-2129.
[4] Pan YS,Chen WQ,Wang YJ.Prediabetes and outcome of ischemic stroke or transient ischemic attack:a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis,2019,28(3):683-692.
[5] Desilles JP,Meseguer E,Labreuche J,et al.Diabetes mellitus,admission glucose,and outcomes after stroke thrombolysis:a registry and systematic review[J]. Stroke,2013,44(7):1915-1923.
[6] 冯翠玲,闫俊强,白树风. 进展性缺血性脑卒中与糖代谢异常的关系[J]. 医学综述,2016,22(5):925-928.
Feng CL,Yan JQ,Bai SF.Study progress about the relation between progressive ischemic stroke and abnormal glucose regulation[J]. Med Recapitul,2016,22(5):925-928.
[7] 卢舒颖,刘宁,廉民学. 糖尿病患者急性卒中后血糖监测及管理的最佳证据总结[J]. 护理学报,2021,28(15):42-47.
Lu SY,Liu N,Lian MX.Best evidence summary of blood glucose monitoring and management in diabetes patients with acute stroke[J]. J Nurs China,2021,28(15):42-47.
[8] 朱政,胡雁,邢唯杰,等. 不同类型循证问题的构成[J]. 护士进修杂志,2017,32(21):1991-1994.
Zhu Z,Hu Y,Xing WJ,et al.The composition of different types of evidence based problems[J]. J Nurs Train,2017,32(21):1991-1994.
[9] Brouwers MC,Kho ME,Browman GP,et al.AGREE II:advancing guideline development,reporting and evaluation in health care[J]. J Clin Epidemiol,2010,63(12):1308-1311.
[10] 胡雁,郝玉芳. 循证护理学[M]. 卫生出版社,2018.
Hu Y,Hao YF.Evidence-based nursing[M]. People's Medical Publishing House,2018.
[11] Shea BJ,Reeves BC,Wells G,et al.AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ,2017,358:j4008.
[12] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志,2015,30(11):964-967.
Wang CQ,Hu Y.JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurs Train,2015,30(11):964-967.
[13] 国家卫生计生委脑卒中防治工程委员会. 中国脑卒中血糖管理指导规范(2015年版)[J]. 全科医学临床与教育,2016,14(1):3-5.
Stroke Prevention and Control Engineering Committee,National Health and Family Planning Commission. Chinese guidelines for blood glucose management in stroke(2015 edition)[J]. Clin Educ Gen Pract,2016,14(1):3-5.
[14] 北京高血压防治协会,北京糖尿病防治协会,北京慢性病防治与健康教育研究会,等. 基层心血管病综合管理实践指南2020[J]. 中国医学前沿杂志(电子版),2020,12(8):1-73.
Beijing Hypertension Association,Beijing Diabetes Prevention and Treatment Association, Beijing Research for Chronic Diseases Control and Health Education,et al. Practise guideline(2020) for integrated management of cardiovascular diseases in primary hospitals[J]. Chin J Front Med Sci Electron Version,2020,12(8):1-73.
[15] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682.
Chinese Society of Neurology,Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol,2018,51(9):666-682.
[16] Fuentes B,Ntaios G,Putaala J,et al.European Stroke Organisation(ESO) guidelines on glycaemia management in acute stroke[J]. Eur Stroke J,2018,3(1):5-21.
[17] Wein T,Lindsay MP,Côté R,et al.Canadian stroke best pra-ctice recommendations:secondary prevention of stroke,sixth edition practice guidelines,update 2017[J]. Int J Stroke,2018, 13(4):420-443.
[18] Kleindorfer DO,Towfighi A,Chaturvedi S,et al.2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline from the American Heart Association/American Stroke Association[J]. Stroke,2021, 52(7):e364-e467.
[19] Korytkowski MT,Muniyappa R,Antinori-Lent K,et al.Manage-ment of hyperglycemia in hospitalized adult patients in non-critical care settings:an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab,2022,107(8):2101-2128.
[20] Kramer AH,Roberts DJ,Zygun DA.Optimal glycemic control in neurocritical care patients:a systematic review and meta-analysis[J]. Crit Care,2012,16(5):R203.
[21] Cerecedo-Lopez CD,Cantu-Aldana A,Patel NJ,et al.Insulin in the management of acute ischemic stroke:a systematic review and meta-analysis[J]. World Neurosurg,2020,136:e514-e534.
[22] Moghissi ES,Korytkowski MT,DiNardo M,et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control[J]. Diabetes Care,2009,32(6):1119-1131.
[23] 中国医师协会内分泌代谢科医师分会,中国住院患者血糖管理专家组. 中国住院患者血糖管理专家共识[J]. 中华内分泌代谢杂志,2017,33(1):1-10.
Chinese Endocrinologist,Chinese Medical Doctor Association,Expert group of blood glucose management for Chinese inpatieents. Expert consensus on blood glucose management for Chinese inpatients[J]. Chin J Endocrinol Metab,2017,33(1):1-10.
[24] Rinkel LA,Nguyen TTM,Guglielmi V,et al.High admission glucose is associated with poor outcome after endovascular treatment for ischemic stroke[J]. Stroke,2020,51(11):3215-3223.
[25] Aziz S,Sheikh Ghadzi SM,Abidin NE,et al.Gender differences and risk factors of recurrent stroke in type 2 diabetic Malaysian population with history of stroke:the observation from Malaysian national neurology registry[J]. J Diabetes Res,2019,2019:1794267.