颅脑创伤早期动态监测血糖对判断预后的作用  

Effects of glucose monitoring after traumatic brain injury on predicting prognosis of the patients

作　　者：徐杨[1] 周健[2] 姚海军[1] 孙一睿[1] 奚才华[1] 贾伟平 胡锦[1] 周良辅[3] 

机构地区：[1]上海市急性创伤急救中心、上海交通大学附属第六人民医院神经外科,上海200233 [2]上海市糖尿病研究所 [3]复旦大学附属华山医院神经外科

出　　处：《中华急诊医学杂志》2009年第5期516-518,共3页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（30371454）;上海市市级医院新兴前沿技术联合攻关项目（SHDC12006101）;联合基金（GM）项目（30422201）

摘　　要：目的动态监测颅脑创伤患者入院后3d内血糖变化，评估高血糖对患者预后的影响。方法以伤后6h入院、既往无糖尿病病史、无严重的合并伤为人选标准选取2007至2008年间颅脑创伤患者62例，监测入院后四个时间点（入院即刻、24h，48h，72h）的静脉血糖值。按GCS（Glasgow Coma Scale）分为轻、中、重型颅脑创伤三组，按预后分为死亡组与存活组，以入院血糖11．1mmol／L为界分为严重高血糖组与轻度高血糖组，用t检验，X^2检验进行组间比较评估高血糖与患者伤情、预后的关系。结果轻、中、重型颅脑伤患者出现不同程度的高血糖，平均血糖随着伤情的加重依次升高；死亡组患者各时间点血糖水平均显著高于存活组，且以入院即刻差异最大[（8．51±2．01）mmol／Lvs．（11．54±2．45）mmol／L，P=0．0001，t=4．988]；严重高血糖组死亡率为64．71％，显著高于轻度高血糖组的13．95％（P=0．0002，X^2=15．46），两组的ICU平均住院天数（ICULOS）分别为22．6d和10．2d，差异具统计学意义（P=0．021，t=3．216），而总住院天数（HLOS）的差异无统计学意义（P=0．052）。结论颅脑创伤后早期出现的应激性高血糖可反映伤情的严重程度，入院血糖〉11．1mmol／L时将预示着患者的高死亡率，可作为早期预测预后的简易指标。Objective To dynamically monitor the blood glucose in traumatic brain injury （TBI） patients within three days after admission, and to assess the impact of hyperglycemia on prognosis. Method Between 2007 and 2008, 62 TBI patients, who were admitted within 6 hours after the incidence of injury without diabetes or severe combined injuries, were involved in this study. Blood glucose was monitored at 4 time points （ instantly, 24 hours, 48 hours, and 72 hours after admission）. Patients were classified into the mild, the moderate, or the se- vere TBI group according to GCS （Glasgow Coma Scale） scores, being classified into the survival or the dead group according to prognosis, or into the mile or severe hyperglycemia group depending on whether the blood glucose ex- ceeds 11. lmmol/L on admission. T tests and X^2 tests were applied to analyze the relationship among blood glucose levels, the degrees of injury, and the prognosis of studied patients. Results Patients with mild, moderate, or severe TBI showed hyperglycemia with different levels, and the blood glucose levels was consistent with the degree of the injury. The blood glucose of the patients in the dead group were significantly higher at all checked time points than those of the survival group, particularly instantly after admission （8.51± 2.01 mmol/L vs. 11.54 ± 2.45 mmol/L, P = 0. 0001, t = 4. 988）. The mortality of patients with severe hyperglycemia was 64.71%, signifi- cantly higher than that of the mild hyperglycemia group 13.95 % （P = 0. 0002, X^2 = 15.46）. The Intensive Care Unit Length of Stay （ICULOS） of the above two groups was 22.6 and 10.2 days, respectively （ P = 0.021, t = 3. 216）, but their hospital length of stay （HLOS） showed no statistical difference （P = 0. 052）. Conclusions Hyperglycemia, as an early stress response to TBI, may reflect the degree of the injury. Blood glucose levels that exceed 11.1 mmol/L on admission may imply high mortality of TBI patients, so this could be used as a simple indicator to

关 键 词：颅脑创伤 血糖 监测 预后 

分 类 号：R651.15[医药卫生—外科学]