-

()Diabetes Care 29:18391844, 200610050

20,2%16,4%19,7%23,9%19,7%Diabetes Care 29:792797, 200632%68% 14% 11,3% 20% IGT 22,7% Age and Ageing; 33: 7177, 2004

;GA Donnan, C Levi Lancet Neurol 2007 ; ; = ;

;

Penumbra 6 8

Na+, K+, Ca+2 DNA , 2

/ + Ca+2 Journal of Clinical Neuroscience 9: 618-626, 2002

;

: = J Cereb Blood Flow Metab 19:288-297,1999 , Stroke 19;623-630,1988 Glu > 126 mg/dl : 3 Stroke 32;2426-2432,2001 Glu > 126 mg/dl 72 h : Stroke 34;2208-2214,2003 Glu > 150 mg/dl : Journal of the Neurological Sciences 255;9094,2007 Glu 100 mg/dl : 24% 75% Neurology 59;669674,2002 Glu > 130 mg/dl : , , 30 , 1 , 6 Neurology 59;6771,2002

Penubra 90 180 270 penubra % 150 100 0 50 (mg/dl)Ann Neurol 52;2028,2002 60%

t-PAP=0,035 158 2 %Stroke 36;1705-1709,2005

t-PAStroke 34;1235-1241,2003 0 100 200 300 400 (mg/dl)30 2010 0- 10- 20- 30NIHSS score 24

J Am Coll Cardiol 26;57-65,1995 , N Engl J Med 345;13591367, 2001 Arch Intern Med 164; 2005-2011,2004 , N Engl J Med 354;449461, 2006

(Glu mmol/L)Malmberg et al(DIGAMI) (n=306)7-10 26% (n=314)Van den Berghe et al (n = 765)4.4-6.1 , , , , (n = 783)10-11.1 35 , 15% Van den Berghe et al 3 4.4-6.1 9,5% 10-11.1

AP-1MMP-9 Egr 1PAI-1TF , ROSNONF Kappa BTNFaMCP-1sICAM-1 Garg R,Stroke 37;267-273, 2006

American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups

Circulation. 115;e478-e534,2007Glu > 140 185 mg/dl , I.V.Class IIa, Level of Evidence C : Glu < 140 mg/dl 1 24

;

stress () GIST-UK, Lancet Neurol 6; 397406, 2007 GKI 933 , (140 mg/dl)24 . GIK ~ 10 mg/dl > GIK: 15,7% Glu > 40 mg/dl: 34% Glu < 40 mg/dl: 22% p = 0.009

VISEP trial : (12,1%)Glucocontrol Study: Van den Berghe et al : 19,6%N Engl J Med 354;449461, 2006 , Infection 33(Suppl 1);19,2005

http://www.clinicaltrials.gov/ct/show/NCT00107601

, ;

vs JAMA 293;437446,2005 , Eur Heart J 26650661,2005 , Crit Care Med 31;359 366,2003

(Glu mmol/L)Mehta et al (CREATE-ECLA) GIK IV (n = 10.110) (n = 10.091)Malmberg et al(DIGAMI 2) (n = 474)7-10510 - (n = 473)710 (n = 306) Van den Berghe et al 4.4-6.1 10-11.1

vs Ellger B, Diabetes 55:10961105, 2006Finney JS, JAMA 290;2041-2047, 2003Van den Berghe G, Crit Care Med 31;359 366, 2003Mebis L, Curr Opin Crit Care 13:392398, 2007Read JL, Cheng EY, AACN 18;200212, 2007

;

Annals of Medicine 37;357364, 20054 P < 0,0001 Stroke 32;2426-2432, 2001

;

lacunar AEEGlu (mg/dl)Lacunar Non-Lacunar OR 3

NEUROLOGY 52;280-284, 1999

Glu (mmol/L) OR Brain, 130;1626-1630, 2007 lacunar AEE

32%20%31%10%7% Stroke/Brain Attack Reporters Handbook Endelwood, Colo: National Stroke Association, 1997

TOAST Tuttolomondo A et al. Nutrition, Metabolism & Cardiovascular Diseases 2007

(%) (%)OR (95% CI)pLAAS36,249,50,380,01CEI9,819,60,570,02LAC4724,53,89< 0.01ODE1,91,40,130,05UDE4,93,92,000,17

Stroke 32;2029-2032, 2001, Stroke 38;2526-2530, 2007

Clement S. Diabetes Care 27;533-591, 2004 - Lien LF, Med Clin N Am 88;10851105, 2004

,

-Clement S. Diabetes Care 27;533-591, 2004 Lien LF, Med Clin N Am 88;10851105, 2004

:

- : -Clement S. Diabetes Care 27;533-591, 2004 Lien LF, Med Clin N Am 88;10851105, 2004

s.c

S.C. Clement S. Diabetes Care 27;533-591, 2004 Lien LF, Med Clin N Am 88;10851105, 2004

i.v.

Lien LF, Med Clin N Am 88;10851105, 2004 Clement S. Diabetes Care 27;533-591, 2004

Pharmacotherapy 25;352359, 2005

Pharmacotherapy 26;14101420, 2006

I.V. , , C s.c. C E E E 1 E

Clement S. Diabetes Care 27;533-591, 2004

:

:

NPO iv

1

2Clement S. Diabetes Care 27;533-591, 20040102030Glargine s.c. ()

1 2 4 6 24:: 1 24: 1 2 : 1 Clement S. Diabetes Care 27;533-591, 2004

400350300250200150100MealSC injection50003060Time (min)90120180210150240 Plasma Insulin (pmol/L)Heinemann, et al. Diabet Med. 1996;13:625-629 Mudaliar, et al. Diabetes Care. 1999;22:1501-15066-28

Clement S. Diabetes Care 27;533-591, 2004

: , , stress.

24

:

< 20 U:

:

: 30 (4,9% 2,7%) Stroke 20;983989,1989

(15.2% 11,4%) Stroke 22;155-161,1996

Stroke 29;2491500,1998

1 Diabet Med 11; 67884,1994

5 25% Diabetologia 33;244249,1990

GRASP trial, THIS trial IRIS trial, NICE and SUGAR study Glu < 180 mg/dl ;