胰岛素治疗重型颅脑损伤高血糖反应对患者预后影响的观察

Effect of high blood glucose and insulin treatment on prognosis of severe head injury

目的 :观察胰岛素治疗重型颅脑损伤后高血糖反应对患者预后的影响。方法 :测定重型颅脑损伤患者第 2日清晨空腹血糖值 ,随机分成胰岛素治疗组和常规治疗组 ,观察治疗 1个月后疗效。结果 :脑外伤血糖水平显著增高 ,其与格拉斯哥昏迷计分 ( GCS)、预后显著相关 ( P<0 .0 1) ,胰岛素治疗组预后与对照组预后无显著性差异 ( P>0 .0 5 )。结论 :测定血糖有助于了解颅脑损伤的严重程度、估计患者的预后。用胰岛素治疗脑外伤后高血糖反应未能改善患者的预后 ,可能与胰岛素开始治疗时间和给药方式等因素有关 ,尚待进一步研究。

Objective:To investigate the relationship between blood glucose (BG) after severe head injury (SHI) and prognosis,and to observe the effect of insulin treatment for hyperglycemia on prognosis.Methods:BG was measured in the next morning after SHI,and 81 patients with SHI were randomly divided into the insulin treatment group and the conventional treatment group.The clinical outcome was observed in one month after treatment.Results:BG significantly increased after SHI.There was a significant correlation between BG,GCS and GOS (P<0.01).No significant difference in outcome was found between the insulin treatment group and the conventional treatment group (P>0.05).Conclusions:Measurement of BG can help us to estimate the severity of head injury and the prognosis of patients.Insulin treatment can not improve the outcome,and the result may be due to many factors,such as the time of beginning of the treatment and the way of using insulin,etc.