重型颅脑损伤合并应激性高血糖患者血糖水平与预后的关系  

Relationship between blood glucose level and outcome of severe traumatic brain injury patients with stress hyperglycemia

作　　者：吕伟豪 费晓炜 武秀权 何鑫 郇宇 吴霜 豆雅楠 费舟 胡世颉 Lyu Weihao;Fei Xiaowei;Wu Xiuquan;He Xin;Yu Huan;Wu Shuang;Dou Yanan;Fei Zhou;Hu Shijie(Department of Neurosurgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院神经外科,西安710032

出　　处：《中华神经创伤外科电子杂志》2023年第6期338-342,共5页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：军队后勤科研重大项目(AWS15J001);陕西省自然科学基金面上项目(2020JM-322);西京医院医学临床应用研究课题项目(JSYXM32);西京医院学科助推计划(XJZT19ML39)。

摘　　要：目的探讨入院伴随应激性高血糖(SH)的重型颅脑损伤(sTBI)患者住院期间随机血糖水平与预后的关系。方法回顾性分析空军军医大学第一附属医院神经外科重症监护室自2013年10月至2022年6月收治的85例sTBI且入院首次随机血糖>11.1 mmol/L患者的住院期间病历资料。根据出院时的GOS评分将患者分为预后良好组(GOS>3分)和预后不良组(GOS≤3分)。比较2组患者的一般资料,采用多因素Logistic回归分析法判断影响患者预后的独立危险因素,分析患者住院期间随机血糖水平与预后的关系。结果纳入的85例患者中预后不良组67例,预后良好组18例。2组患者住院期间的随机血糖水平比较差异有统计学意义(P<0.05),且血糖>11.1 mmol/L是sTBI患者预后的独立危险因素。26例患者住院期间并发感染,其中预后良好组3例,预后不良组23例,2组患者的感染率比较,差异无统计学意义(P>0.05)。随机血糖水平>11.1 mmol/L的患者均较≤11.1 mmol/L的感染率升高,但差异均无统计学意义(P>0.05)。结论sTBI合并SH患者住院期间的随机血糖水平与预后有关,且血糖>11.1 mmol/L是sTBI患者预后的独立危险因素。Objective To explore the relationship between the random blood glucose level and the outcome of severe traumatic brain injury(sTBI)patients with stress hyperglycemia during hospitalization.Methods The in-hospital medical records of 85 patients with sTBI and first-admission random blood glucose>11.1 mmol/L admitted to the Neurosurgical Intensive Care Unit of the First Affiliated Hospital of Air Force Military Medical University from October 2013 to June 2022 were retrospectively analyzed.Patients were divided into good outcome group(GOS>3 score)and poor outcome group(GOS≤3 score)according to their GOS score at discharge.The general information of two groups was compared,the multivariate Logistic regression analysis was used to identify risk factors affecting patient prognosis,and the relationship between random blood glucose levels during hospitalization and prognosis was analyzed.Results Of the 85 patients included,67 had poor outcome and 18 had good outcome.The difference in random blood glucose levels between the two groups during hospitalization was statistically significant(P<0.05),and blood glucose>11.1 mmol/L was an independent risk factor for the prognosis of sTBI patients.During hospitalization,26 patients developed concurrent infections,including 3 in the group with good outcome and 23 in the group with poor outcome,there was no statistically significant difference in infection rates between the two groups(P>0.05).Patients with random blood glucose>11.1 mmol/L had significantly higher infection rates compared to those with≤11.1 mmol/L,but the differences were not statistically significant(P>0.05).Conclusion Randomized blood glucose levels during hospitalization in patients with sTBI and SH are associated with prognosis,and blood glucose levels>11.1 mmol/L are independent risk factors for the prognosis of sTBI patients.

关 键 词：重型颅脑损伤 二次脑损伤 应激性高血糖 预后 

分 类 号：R651.15[医药卫生—外科学]