严重脑外伤患者伤后血糖水平与病情、预后的相关性研究

Study on the Correlation of the Blood Glucose Levels with the Disease State,and Prognosis of the Patients after Severe Traumatic Brain Injury

目的探讨严重脑外伤患者伤后血糖水平与病情、预后的关系。方法收集严重脑外伤患者130例,根据Glasgow昏迷评分法分为7~8分组（n=46）、5~6分组（n=58）、≤4分组（n=26）,比较3组血糖水平及伤后高血糖维持的时间及预后情况。结果 3组患者入院24 h、3 d时血糖逐渐升高,入院后第5天、第8天时逐渐下降,但仍高于正常水平（P〈0.05）。在相同的时间点7~8分组血糖水平低于5~6分组,5~6分组血糖水平低于≤4分组（P〈0.05）。7~8分组高血糖持续时间短的比例最高,≤4分组高血糖持续时间长的比例最高（P〈0.05）。Glasgow昏迷评分与血糖水平呈负的相关性（r=-0.68,P=0.O0）。7~8分组死亡率明显低于5~6分组及≤4分组,≤4分组死亡率最高。结论严重颅脑损伤患者的入院血糖水平与其病情及预后存在一定的相关性。因此动态的监测患者血糖水平结合Glasgow昏迷评分,可较准确、快速的评估严重颅脑损伤的严重程度及预后。

Objective To investigate the correlation of the blood glucose level with the disease state and prognosis of the patients after severe traumatic brain injury. Methods 130 patients with severe traumatic brain injury were selected and divided into 7 ~8points group（n=46）, 5~6 points group（n=58）, ≤4 points group（n=26） according to Glasgow Coma Scale. The blood glucose level,the duration of hyperglycemia after the injury and prognosis of the three groups were compared. Results The blood glucose level of the three groups at 24 hours, 3 days after being hospitalized gradually increased, though it decreased progressively at 5 days, 8days after being hospitalized, still higher than the normal level（P〈0.05）. At the same time point, the blood glucose level of 7~8points group was lower than that of 5~6 points group, and that of 5~6 points group was lower than that of ≤4 points group（P〈0.05）. The proportion of patients whose hyperglycemia duration was short in 7~8 points group was the highest, and the proportion of patients whose hyperglycemia duration was long in ≤ 4 points group was the highest（P〈0.05）. There was a negative correlation between Glasgow Coma Scale and blood glucose level（r=-0.68, P=0.00）. The mortality in 7~8 points group was significantly lower than that in 5~6 points group and in ≤ 4 points group, the mortality in ≤ 4 points group was the highest. Conclusion There is a certain correlation of the blood glucose level with disease state and prognosis of hospitalized patients with severe traumatic brain injury. Therefore, dynamically monitoring the blood glucose level combined with Glasgow coma scale can accurately and rapidly assess the severity and prognosis of severe craniocerebral injury.