创伤死亡不同血糖水平患者存活时间、感染率和MODS发生率病历调查

Relationship of hyperglycemia to infection,MODS,and survival time in dead trauma patients

目的研究创伤死亡不同血糖水平患者院前创伤评分(revised traum a score,RTC;glasgow com a scale,GCS)、3 d后死亡构成比、感染率和多器官功能不全综合征(mu ltipe organ dysfunction syndrom e,MODS)发生率的变化。方法随机抽查本院1999年1月至2005年1月455份住院创伤死亡病历,根据空腹血糖水平及正常参考范围分为创伤死亡正常血糖组57例和创伤死亡高血糖组298例。统计创伤死亡不同血糖水平组RTC、GCS、3 d后死亡构成比、感染率和MODS发生率及的变化,并计算创伤死亡患者血糖与MODS相关定量指标的相关系数。结果①创伤死亡高血糖组RTC为6.31±1.04,GCS为4.23±0.52;创伤死亡正常血糖组RTC为4.43±0.22,GCS为2.21±0.34。创伤死亡高血糖组院前创伤评分明显高于创伤死亡组正常血糖(P<0.01)。②创伤死亡高血糖组3 d后死亡构成比为67.34%,创伤死亡正常血糖组3 d后死亡构成比为17.54%。创伤死亡高血糖组3 d后死亡构成比明显高于创伤死亡正常血糖组(P<0.01)。③创伤死亡高血糖组感染率为83.92%,MODS发生率为71.86%;创伤死亡正常血糖组感染率为21.05%,MODS发生率为10.53%。创伤死亡高血糖组感染率和MODS发生率均明显高于创伤死亡正常血糖组(P<0.01)。④455例创伤死亡患者血糖水平与血ALT、AST、BUN、CRE、PCO2、CK明显正相关(P值均<0.01)。结论创伤死亡高血糖患者院内存活时间长,感染率和MODS发生率高。创伤死亡正常血糖患者伤情重,存活时间短,感染率和MODS发生率低。创伤高血糖患者死亡因素以感染和MODS为主,创伤正常血糖患者死亡因素以非MODS因素(大出血和颅脑直接损伤等)为主。创伤血糖水平升高可作为创伤MODS预警指标,但血糖正常预后也不一定好。

Objective To investigate the relationship of hyperglycemia to trauma score, infection, MODS and survival time of the dead patients caused by trauma. Methods A total of 455 cases of dead trauma patients selected randomly from our hospital, were divided into two groups with normal blood glucose （n = 57） or hyperglycemia （ n = 298）. The RTC, GCS and the cases of infection and MODS as well as the survival time of two groups were recorded, and the coefficients of relationship between the blood glucose and the indexes of MODS in the dead trauma patients were calculated. Results The levels of RTC,GCS in the group with hyperglycemia were higher than that with normal blood glucose （ P 〈 0.01 ）. The rate of survival time more than 3 days in the group with hyperglycemia were higher than that with normal blood glucose （ P 〈 0.01 ）. The rates of infection and MODS in the group with hyperglycemia were higher than that with normal blood glucose （P 〈 0.01 ）. There was positive correlation between the hyperglycemia and the indexes of MODS of dead trauma patients（ P 〈 0.01 ）. Conclusion The dead trauma patients with hyperglycemia have a long survival time and a high risk of infection and MODS, and the changes of fasting blood glucose may contribute to the diagnosis of MODS caused by trauma. The dead trauma patients with normal blood glucose have a low risk of MODS, but represents a serious wound degree and short survival time. The MODS may be the primary reason for the dead of trauma patients with hyperglycemia, and the massive haemorrhage and serious brain injured may be the primary reason for the dead of trauma patients with normal blood glucose.