経腸経管栄養を受ける急性期脳卒中患者の高血糖に対する持続血糖測定

Continuous Blood Glucose Monitoring of Hyperglycemia in Acute Stroke Patients Receiving Enteral Tube Feeding

脳卒中急性期に経管栄養を投与すると高血糖をきたすことが多いが，血糖値の経時変化は明らかになっていない。経管栄養で高血糖になった脳卒中患者6名に持続血糖測定を行い，血糖値曲線の特徴を調べた。6名の空腹時血糖値（中央値）は125.5mg/dL，最高血糖値（中央値）は351.5mg/dL。血糖値曲線は，投与開始後ゆっくりと上昇し3〜4時間後に最高値となり，その後ゆっくり下降するものとほとんど下降しないものがあった。この特徴は糖尿病の診断とは関係なくみられた。血糖曲線を4パターンに分類した。

Abstract

Severe hyperglycemia often occurs when acute stroke patients receive enteral tube feeding. Hyperglycemia should be managed because it adversely affects stroke outcome. However, it remains unclear how blood glucose level (BGL) changes with enteral nutrition in acute stroke patients. Our purpose was to investigate features of the blood glucose curve in acute stroke patients receiving enteral feeding. We retrospectively evaluated acute stroke patients who developed hyperglycemia during enteral tube feeding and underwent CGM in our institution. We evaluated characteristics of blood glucose curves, fasting and peak BGL, and time to peak of BGL. Six patients were analyzed. The median fasting BGL was 125.5 mg/dL and the median peak BGL was 351.5 mg/dL. The blood glucose curve showed the following characteristics following: 1) BGL elevated slowly reach the peak in 180 to 240 minutes; 2) BGL decreased slowly or very little after its peak; 3) there was a large gap between fasting and peak BGL regardless of presence of diabetes mellitus. We grouped the curves into four types by time to peak and how BGL decreased after peak.

(Received August 17, 2017; Accepted February 1, 2018; Published July 1, 2018)