血糖波动对重型颅脑损伤患者早期预后的影响  

Effect of blood glucose fluctuation on the prognosis of critical craniocerebral disease patients

作　　者：徐坡[1] 陆士奇[1] 孙腾[1] 

机构地区：[1]苏州大学附属第一医院急诊科,江苏苏州215006

出　　处：《中国急救医学》2014年第5期400-403,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨血糖波动与重型颅脑损伤患者早期预后的关系，为临床治疗提供理论依据。方法选择2012—09～2013—05入住苏州大学附属第一医院急诊重症监护病房（ICU）的患者，入院当天急性生理学与慢性健康状况11（APACHEll）评分≥15分，ICU住院时间≥3d，GCS评分4—8分的52例重型颅脑损伤患者进行血糖监测及预后观察。血糖监测终点为转入ICU后72h，预后观察终点为转入ICU后28d；计算患者转入ICU时的APACHEII评分，平均血糖（GluAve），血糖变异性指标[血糖标准差（GluSD），血糖变异系数（GluCV），第1、2、3天及72h的血糖不稳定指数（GLI-1、GLI-2、GLI-3、GLI-3d）]。按患者预后情况分为死亡组（n=25）及生存组（n=27），比较两组间APACHEII评分、血糖变异性、炎症因子、超敏C反应蛋白（hs—CRP）水平、颅脑损伤程度特异性指标神经元特异性烯醇化酶（NSE）及28d病死率的差异。结果死亡组APACHEII评分明显高于生存组（P〈0．05），死亡组hs—CRP及NSE均明显高于生存组（P〈0．05），死亡组患者的GluSD、GluCV、GLI-1、GLI-3d、低血糖发生率及72h胰岛素（RI）总用量均明显高于生存组（P〈0．05），初始血糖（GluAdm）和GluAve比较差异无统计学意义（均P〉0．05）。且GLI-3d的AUC为0．901，对预后诊断有较高的准确性。结论重型颅脑损伤患者的血糖波动与28d死亡率密切相关，控制血糖波动，保持血糖稳定比控制高血糖更为重要。Objective To determine the correlation between glucose fluctuation and the prognosis of critical eraniocerebral disease patients. Methods A prospective study involving 52 critical craniocerebral disease patients with acute physiology and chronic health evaluation 1] （ APACHE II ） value in admission day ≥15, the duration of intensive care unit （ICU） stays 23 days, 4≤the value of GCS ≤8 in our hospital＇s ICU. Blood glucose monitoring and prognosis observation were performed for the 52 patients admitted in ICU from September 2012 to May 2013. Blood glucose monitoring terminal was 72 hours after admitting in ICU, prognosis was observed for 28 days after the end of turning into ICU. APACHE I1 scores when transferred into ICU, the average blood glucose （GluAve）, blood glucose variability [ glucose standard deviation （ GluSD）, coefficient of variation glucose （ GluCV）, the glycemic instability index （GLI） of the 1st day, the 2nd day, the 3rd day and 72 hours] were calculated. According to the patients＇prognosis on the 28th day, the 52 patients were divided into survival group （n = 27） and death group （ n = 25 ）, and the APACHE II score, blood glucose variability, insulin resistance, the levels of hs -CRP and NSE, 28 -day mortality were compared in two groups. Results Compared with survivor group, in death group, the levels of APACHE 11 , hs - CRP, NSE, GluSD, GluCV, GLI - 1, GLI - 3 d were increased （ all P 〈 0.05 ）, but the levels of GluAdm and GluAve of two groups have no significant difference （ all P 〉 0.05 ）. When ROC was applied, the area under the curve （AUC） of GLI-3d was 0.901±0. 042; it was higher than that of GLI- 1/GLI-2 and GLI-3 （all P 〈 0.05）. Conclusion Fluctuation of blood glucose has tight relation to short - term mortality （28 days） in the critical craniocerebral disease patients. Therefore, it is more imperative to stabilize the blood glucose level than to lower it in the treatment of critical craniocerebral disease patients.

关 键 词：重型颅脑损伤 血糖波动 血糖不稳定指数 预后 

分 类 号：R651.15[医药卫生—外科学]