重型颅脑损伤时血糖水平与颅内压及预后的关系

Hyperglycemia,intracranial pressure and prognosis of patients with severe craniocerebral injury

目的:探讨严重颅脑损伤患者血糖水平与病情严重程度及颅内压和预后的关系。方法:第四军医大学唐都医院2001-09/2003-08神经外科收治284例严重颅脑损伤患者,发病后12h内入院未输注含糖液体。按入院时CT检查结果分硬膜外血肿(n=98)、急性硬膜下血肿(n=67)、脑内血肿(n=119)。依据格拉斯哥昏迷量表计分将患者病情严重程度分为3组:三四分组(n=78)、五六分组(n=85)、七八分组(n=121)。全部患者进行外科手术治疗,硬膜外放置颅内压监护装置进行颅内压监测。入院时和术后测定血糖。依据治疗结果(6个月后的格拉斯哥结局量表计分)将患者分为两组:效果良好组(≥4分)、效果差组(≤3分)。结合临床病情、颅内压及治疗效果进行对比研究。结果:284例患者全部进入结果分析。①根据格拉斯哥昏迷量表计分分组,在入院时和术后三四分组的血糖水平高于七八分组[(12.0±0.8),(11.4±0.5),(10.2±0.6),(9.7±0.8)mmol/L,P<0.05]。在每组中入院时与术后的血糖水平相比没有显著差别(P>0.05)。②根据CT检查分组发现,硬膜外血肿组、急性硬膜下血肿组、脑内血肿组血糖水平在入院时和术后均没有明显差别(P>0.05)。③根据治疗结果分组,入院时和术后的血糖水平比较,效果差组明显高于效果良好组[(11.8±0.5),(9.8±0.5),(11.5±0.4),(8.1±0.3)mmol/L,P<0.01]。④颅内压与入院时血糖水平没有明显的相关,然而在术后24h内最大颅内压值和术后血糖水平相关(r=0.383,P<0.01),术后血糖值越高,其颅内压也越高。结论:血糖水平与脑损伤的严重程度、颅内压及治疗效果密切相关,高血糖越高病情越严重。术后血糖越高,颅内压越高,治疗效果越差,预后不良。血糖水平是判断严重颅脑损伤预后的重要指标之一。

AIM:To study the association of hyperglycemia with severity of disease,intracranial pressure and prognosis after severe craniocerebral injury. METHODS:Totally 284 patients suffering from severe craniocerebral injury were treated in the Department of Neurosurgery,Tangdu Hospital of Fourth Military Medical University of Chinese PLA from September 2001 to August 2003.All patients were hospitalized within 12 hours of onset and received no liquid containing sugar.They were divided into epidural hematom(n=98), acute subdural hematoma(n=67) and intracerebral hematoma groups(n=119) according to the CT result on hospitalization,3 or 4 score group(n=78),5 or 6 score(n=85) and 7 or 8 score group(n=121) based on Glasgow coma scoring.All patients received surgical intervention and intracranial pressure was detected by using an epidural intracranial pressure measuring system. The level of serum glucose was examined on hospitalization and after operation.The patients were divided into two groups according to Glasgow coma score after 6 months:good effect group(≥4 scores) and bad effect group(≤3 scores).The results were compared in combination with severity of injury, intracranial pressure and intracranial pressure accordingly.RESULTS:All 284 patients were involved in the result analysis.①The level of serum glucose on hospitalization and after operation increased in 3 or 4 score group as compared with that in 7 or 8 score group[(12.0±0.8), (11.4±0.5),(10.2±0.6),(9.7±0.8) mmol/L,P< 0.05].There was no significant difference in the level of serum glucose on hospitalization and after operation in each group(P >0.05).②The result of CT indicated there was no significant difference in the level of serum glucose on hospitalization and after operation in epidural hematom, acute subdural hematoma and intracerebral hematoma groups(P >0.05).③The level of serum glucose was higher in bad effect group than that in good effect group on hospitalization and after operation[(11.8±0.5) vs (9.8±0.5),(11.5±0.4) vs (8.1±0.3) mmol/L,P< 0.01].④There was no significant association between intracranial pressure and the level of serum glucose on hospitalization,however,maximum intracranial pressure was associated with the level of serum glucose within 24 hours after operation(r=0.383,P< 0.01);the higher the level of serum glucose was,the higher the intracranial pressure was.CONCLUSION:The level of serum glucose is associated with the severity of injury, intracranial pressure and therapeutic efficacy.Hyperglycemia indicates serious disease.After operation, the higher the level of serum glucose and the intracranial pressure are,the worse the therapeutic efficacy and the prognosis are.The level of serum glucose is a significant indicator on severity head injury,and a reliable predictor of prognosis.