The effect of blood glucose monitoring on clinical results in acute ischemic stroke patients with intravenous trombolitic treatment

OBJECTIVE: The aim of this study was to investigate the effects of hyperglycemia, which accompanies acute ischemic stroke patients who applied to our clinic within the first 4.5 hours and who received intravenous thrombolytic therapy, on the response to treatment, short and long term prognosis. METHODS: This retrospective study was performed by scanning the data in the hospital archive and automation system of 90 patients who were administered intravenous thrombolytic therapy for acute ischemic stroke at Dursun Odabaş Medical Center, Van Yüzüncü Yıl University Faculty of Medicine. The demographic features and imaging findings of the patients were analyzed. Hourly serial blood glucose measurements were made at the time of intravenous thrombolytic therapy and for 24 hours. In the evaluation of treatment efficacy, for the short term was made by comparing admission to the hospital NIHSS with NIHSS after treatment and measuring mRS during discharge, and measuring the 3rd month mRS for the long term. RESULTS: Of the 90 patients included in the study, 38 (42.2%) were male and 52 (57.8%) were female. The ages of the patients in the study ranged between 33 and 88, and the mean age was 68.2 ± 10.9. Pre-treatment of 26 patients (28.9%) 0-8 NIHSS score of 21 (23,3%) NIHSS score 9-14, 43 (47.8%) NIHSS score 15-30 that was detected. Blood glucose values were measured every hour during intravenous thrombolytic therapy and during the 24-hour follow-up. 32 of the patients (35.6%) average blood glucose is below 140 mg/dl, 58'n of (64.4%) were above the blood sugar values 140 mg/dl and 140 mg/dl above. In the group with blood glucose 140 mg/dl and above, both the initial NIHSS value and the NIHSS value at the 24th hour after treatment were significantly higher (p ˂ 0.05) than the group with blood glucose below 140 mg/dl. In the group with blood glucose 140 mg/dl and above, the 24-hour NIHSS decrease (treatment response) was significantly lower (p ˂ 0.05) than the group with blood glucose below 140 mg/dl. When the control brain CTs of the patients were examined, celebral hemorrhage was detected in 27 (30.0%) of the patients, while no celebral hemorrhage was observed in 63 (70.0%). There was no statistically significant relationship celebral hemorrhage and blood glucose values per hour in the control CTs of the patients. Fazekas scores at the time of diagnosis were calculated. There were 40 (44.4%) patients in the Fazekas 0-I group and 50 (55.6%) patients in the Fazekas II-III group. It was observed that the group with the Fazekas score II-III had higher blood values than the group with the Fazekas score 0-I. In the group of patients with high blood glucose, the exit / discharge mRS and mRS scores at the 3rd month were significantly higher than the group with low blood sugar (p<0.05). 13 CONCLUSION: In the presence of hyperglycemia, the effectiveness of intravenous thrombolytic therapy decreased and the disability rate also increased in the following period. Hourly serial blood glucose measurements made after the start of treatment is a more intervenable parameter compared to a single measurement. Strict glucose control for 24 hours from the start of intravenous thrombolytic therapy can affect the results of our treatment in a good way and reduce the complications such as intracranial hemorrhage.