重型颅脑损伤患者血糖、胰岛素、胰高血糖素以及颅内压监测的临床研究

Clinical Investigation on the Association of Hyperglycemia,Insulin,Glucagons and Intracranial Pressure After Severe Brain Injury

【目的】研究重型颅脑损伤患者血糖、胰岛素、胰高血糖素以及颅内压的变化及临床意义。【方法】217例颅脑损伤患者,按照GCS评分分为3组：其中3-4分组：81例,5-6分72例,7-8分64例。监测患者血糖、胰岛素、胰高血糖素以及颅内压变化。预后判断在伤后6个月进行,根据GCS评分分为两组：预后良好组GCS（4-5分）,预后较差组GCS（1,2,3分）。分析血糖、胰岛素、胰高血糖素水平与患者预后的关系。【结果】GCS评分不同的三组,入院以及术后血糖以及胰高血糖素水平比较,差异有显著性（P〈0.05）,胰岛素水平在GCS（3-4分）组与GCS（7-8分）组间比较差异有显著性（P〈0.05）,GCS（5-6分）组与GCS（7-8分）组间比较差异无显著性（P〉0.05）。血糖与颅内压以及胰高血糖素呈正相关（均P〈0.05）。预后良好组血糖、胰岛素、以及胰高血糖素水平较预后较差组低,且差异有显著性（P〈0.05）。【结论】重型颅脑损伤患者进行血糖、胰岛素以及胰高血糖素水平监测可以辅助我们对于患者病情以及预后进行准确的判断,同时胰岛素与胰高血糖素的监测能够辅助临床医生对于高血糖的发生机制进行判断。

[Objective] To explore the clinical significance of the hyperglycemia, insulin, glucagons and intracranial pressure in the patients with severe brain injury. [Methods]Two hundred and seventeen patients suffering form severe brain injury were divided into three groups based on Glasgow coma scoring, 3 or 4 score group （ n =81）, 5 or 6 score group （ n =72）, 7 or 8 score group （ n =64）. The blood glucose, insulin, glucagons, and intracranial pressure were examined. The patients were divided into two groups according to Glasgow coma score after 6 months： good effect group （4 or 5 score） and bad effect group （1, 2, or 3 score）. The association of the hyperglycemia, insulin, glucagons and outcome following the treatment in the patients with severe brain injury were evaluated. [Results] The blood glucose examined on hospitalization and after operation and glucagons were different significantly among three groups（ P 〈0. 05）. The level of insulin was different significantly between 3 or 4 score group and 7 or 8 score group, and no significant difference has been found between 5 or 6 score group and 7 or 8 score group（ P 〉0.05）. The blood glucose was positive related with intracranial pressure and level of glucagons （r1 = 0.51127, P〈0.05, r2 = 0. 6133, P 〈0.05）. The blood glucose, insulin and glucagons were significantly different between good effect group and bad effect group （ P 〈0.05）. [Conclusion]The examination of blood glucose, insulin and glucagons can help us to predict the outcome of the patients suffering from the severe brain injury, and also to explore the mechanism of the hyperglycosemia.