47例重型颅脑损伤患者高血糖临床分析

Clinical analysis for 47 cases of hyperglycemia on severe head injury patients

目的探讨重型颅脑损伤后高血糖的临床特点。方法47例重型颅脑损伤患者，入院即刻及以后每4h监测血糖水平等资料。按年龄、伤前有无糖尿病史、有无合并伤、死亡和存活分组。分析上述因素与伤后高血糖的关系。结果术后高血糖发生率82．9％。〈40岁患者与≥40岁患者伤后高血糖的发生率有显著差异（χ＾２=5．21，P〈0．05）。有无糖尿病史伤后高血糖的发生率无差异（χ＾２=3．31，P〉0．05）、，有无合并损伤，伤后高血糖的发生率有显著差异（χ＾２=6．54，P〈0．05）。死亡者平均血糖峰值与存活者相比有显著差异（t＝2．607，P〈0．05）。结论重型颅脑损伤伤后高血糖的发生率较高。与伤者年龄、有无合并伤有关。与伤前是否存在糖尿病无明显相关性。血糖峰值与预后密切相关。

Objective This study was to investigate the hyperglycemia clinical features after severe head injury. Methods 47 cases of patients with severe head injury, collected with the data including the blood glucose level at admission and every subsequent 4 h. They were di- vided referring age, diabetes mellitus before injury,combined injuries, death and survival. Then we analyzed the relationship between the above factors and the hyperglycemia after injury. Results The incidence of hyperglycemia after surgery was 82. 9%. The incidence of hyperglycemia was significantly different between patients 〈 40 - years - old and ≥40 - years - old （χ^2 = 5.21, P 〈 0. 05 ）. It had no significant difference be- tween diabetes patients and nondiabetic patients（χ^2 = 3.31 ,P 〉 0. 05）. But it had significant difference between the patients with combined injury and without combined injury （χ^2 = 6. 54, P 〈 0. 05 ）. It also had significant difference on the blood glucose peaks between death and survival （t = 2. 607, P 〈 0. 05 ）. Conclusion A higher incidence of hyperglycemia existed in severe head injury, and the age, with or without combined injuries related, but it had no obvious correlation with the existence of diabetes before injury. The peak of blood glucose was related with the bead injury prognosis closely.