重度颅脑损伤后血糖变化与预后的关系

The relationship between serum g lucos levels and prognosis in patients with severe head injury

目的:探讨重度颅脑损伤后血糖升高与病情及预后的关系.方法:对我院213例重度颅脑损伤病人入院后72小时测定的空腹血糖进行回顾性分析,比较高血糖组(＞6.10 mmol/1)与正常血糖组的Glasgow outcome scale(GOS)评定,同时也比较了不同Glasgow coma scale(GCS)水平的血糖水平与预后的关系.结果:高血糖组GOS良好率(24.7%)低于正常血糖组(37.9%),而死亡率(41.5%)高于正常血糖组(23.3%),GCS3～5分组中血糖值在(10.3±5.2)明显高于GCS6±8分组(9.0±2.2)且GCS3～5分组中高血糖(＞15 mmol/l)组中死亡率为58.0%,明显高于其他分组,以上数据经统计学处理差异均有显著性(P＜0.05).结论:重度颅脑损伤病人早期因应激反应易出现血糖升高,同时伤情越重血糖越高,预后也越差.

Objective ： To study the elationship between serum g lucos levels and neurologiccal prognosis in the patients with severe head injury. Methods ： The empty abdomen serum glucosis levels of 213 patients with severe head injury （GCS 〈 8） within 72 hours after admission were retrospectively compare not only the good outcome rate and mortality （GOS） in the hyperglycemia group （ gl analyzed to ueose value 〉 6.10mmol/L） with those in normoglucemia group, but also the glucose levels of different GCS in hyperglucemia group. Results ： The than in normoglucemia group （37.9 good outcome rate was lower in the hyperglycemia group （24.7 % ） than in normoglucemia group（37.9% ） （ P 〈 0.05）, but the mortality was higher in the hyperglycemia group （41.5%） than in the normoglycemia group （23.3%） （P 〈 0.05）. The glucose levels were significantly higher in GCS 3 - 5 group （ 10.30 ± 5.20 mmol/L） than in GCS 6 - 8 group （9.0 ± 2.2 mmol/L） （P 〈0.05）. Farther analyze showed the mortality in GCS 3- 5 group （58.0%）was higher in the hyperglycemia group （ P 〈 0.05）. Conclusion ： Patients with severe head injury mostly develop serum glucose levels due to such factors as stress or brain stem and hypothalamus injuries. The severer head injury , the higher glucose levels and poorer neurological prognosis. Hyperglycemia was one of the major factors resulting in deaths of the patients with severe head injury.