重型颅脑外伤患者亚低温治疗后血糖及胰岛素变化的动态观察  

Continuous investigations on changes of blood sugar and insulin in patients with severe traumatic brain injury

作　　者：吴江[1] 周育瑾[1] 徐建民[1] 林晓元[1] 林合麟[1] 黎国雄[1] 

机构地区：[1]深圳市西乡人民医院神经外科,深圳518102

出　　处：《中国神经精神疾病杂志》2001年第6期415-417,共3页Chinese Journal of Nervous and Mental Diseases

基　　金：深圳市科委自然科学基金赞助项目(编号:199805019)

摘　　要：目的 探讨亚低温治疗对重型颅脑外伤患者血糖代谢的影响及临床意义。方法 把重型颅脑外伤6５例随机分为亚低温治疗组（３２例）和常规治疗组（３３例）。舶组于入院或急诊手术后即用亚低温治疗，将直肠温度控制于３３－３５℃，持续３－５ｄ；后组行常规治疗。并按Ｇｌａｓｇｏｗ预后分级评定患者的预后。两组分别于入院后及治疗后第１、３、５、７ｄ检侧血糖和胰岛素含量，观察其动态变化，并分析与顶后的关系。 结果 重型颅脑外伤后血糖及胰岛素水平均升高。亚低温组治疗５－７ｄ后血糖水平较治疗后１ｄ及常规组治疗同一时期显著下降，两组观察期内胰岛素水平则无显著差异。亚低温组病死率为２８．１％，常规组病死率为５４．５％。入院时血糖≥１１ｍｍｏｌ／Ｌ者预后较差。结论 亚低温治疗有可能通过缓解机体强烈的应激反应，导致血糖水平下降，从而减轻颅脑损伤患者糖代谢紊乱，并改善预后。Objective To investigate the effect and clinical significance of mild hypothermia on the glycometabolism in pa- tients with severe brain injury. Methods Sixty-five patients with severe brain injury were divided randomly into tw groups: for the mild hypothermia therapy group(a = 32), mild hypothermia was used immediately after admission or emergency surgery to keep the rectal temperature at 33 - 35℃ for three to five days; for the routine therapy grop(n = 33), routine therapy was taken. Prognosis was assessed by GCS scores. The levels of blood sugar cud insulin were measured at 1 day, 3 day, 5 days mtd 7 days af- ter admission aitd therapy respectively in each group, at the same time investigating their continuous changes and analyzing their re- lations with prognosis. Results Ti-ic levels of both blood sugar and insulin after severe brain injury increased After live to seven days’mild hypothermia therapy, the levels of blood sugar decreased more markedly than that of I day after therapy and that of con- trol group as well, however, the levels of insulin had no significant difference between two groups. The mortality of mild hypother- mia therapy group was 28. 1 percent, wile that of control group war, 54 . 5 percent. The patients whose levels of blood sugar were higher than cr equal to 11 mmol/ L itt admission had a worse prognosis. Conclusions Mild hypothermia can reduce the level of blood sugar, possibly through alleviating inten,e stress reaction. As a result, it can ameliorate the disturbance of glycometablism and improve the prognosis of such patients.

关 键 词：颅脑损伤 亚低温治疗 血糖 胰岛素 

分 类 号：R651.15[医药卫生—外科学]