重型颅脑损伤后高血糖与颅内压及预后的关系

Relationship of hyperglycemia with intracranial pressure and neurological outcome after severe brain injury

目的明确高血糖对重型颅脑损伤患者颅内压(intracranial pressure,ICP)及预后的影响。方法回顾分析符合以下条件的重型颅脑损伤患者79例无糖尿病史,均施行颅内血肿清除术,无重要颅外合并伤,有伤后6个月格拉斯哥预后评分(GOS)。根据GOS,将79例患者分为预后良好组及预后较差组,分析两组间伤后血糖与颅内压及预后的关系。结果伤后血糖(包括入院及术后血糖)与颅内压呈正相关;预后良好组伤后血糖较预后较差组低,二组差异有统计学意义(P<0.05)。结论重型颅脑损伤后高血糖与颅内压呈线性相关,并且高血糖能够作为早期预测颅内压及预后的简便指标。

Objective To observe the effect of hyperglycemia on intracranial pressure （ICP） and neurological outcome following severe brain injury. Methods A retrospective review was done on 79 cases with severe traumatic brain injury （with no history of diabetes or important extracranial complications） who underwent craniotomy for evacuation of intracranial hematoma and were divided into two groups based on Glasgow outcome scales （GOS） score, ie, favorable group with GOS of 5 or 4 and unfavorable group with COS less than 3. Statistical analysis of data was accomplished by using SPSS 11.5 software. The outcome was assessed at the 6th month after injury. Results A significant correlation was found between ICP levels and admission or postoperative glucose values. The unfavorable group had significantly higher glucose levels both on admission and after operation compared with the favorable group, with statistical difference （P 〈 0.05）. Conclusions Hyperglycemia is positively correlated with ICP, and the serum glucose level can be used as early and simple prognostic indicator.