成人颅脑外伤去骨瓣减压血肿清除术中高血糖症相关危险因素的研究

Risk factors in traumatic brain injured adult patients with hyperglycemia during the decompressivecraniectomy hematoma operation

目的颅脑外伤（TBI）患者出现高血糖症预示着预后不良,成人TBI去骨瓣开颅减压血肿清除术中高血糖症的相关危险因素尚未见报道,该研究旨在分析TBI急症行去骨瓣开颅减压血肿清除术术中高血糖症发生率及相关危险因素。方法 2008年1月-2013年1月因TBI急症行去骨瓣开颅减压血肿清除术成人患者163例,既往均无糖尿病史,其中术前存在高血糖症患者21例。在麻醉前和手术中每1小时测定动脉血糖1次。观测术中高血糖症（血糖≥11.1 mmol/L）、低血糖（血糖≤3.33 mmol/）的发生率和血糖的变化来确定术中高血糖症的相关危险因素。结果术中未见低血糖,术中高血糖症25例（15%）。引起术中高血糖症的相关危险因素是年龄≥65岁、术前格拉斯哥昏迷评分（GCS）〈9、昏迷、术前存在高血糖症（P〈0.05）。术中高血糖症与术后住院期间的死亡相关（OR 2.872,95%CI：1.160-7.112,P=0.023）,术中高血糖症患者术后住院期间的死亡率（40%）高于术中非高血糖症患者（19%）（P=0.019）。结论成人TBI颅骨切除术患者术中高血糖症的发生率是15%,引起术中高血糖症的危险因素是年龄≥65岁、重度TBI（GCS评分〈9分）、昏迷、术前存在高血糖症。术中高血糖症增加术后住院期间的死亡率。

[Objective] To find the incidence of the hyperglycemia and the relative risk factors in traumatic brain injury adult patients during the decompressive craniectomy hematoma operation. [Methods] 163 cases with no history of diabetes mellitus of traumatic brain injury were studied. 21 patients had hyperglycemia pre-operation. Artery blood glucose was measured pre-operation and every 1 h during the decompressive craniectomy hematoma operation. The incidence of hyperglycemia （blood glucose ≥ 11.1 mmol/L） and hypoglycemia （blood glucose ≤ 3.33 retool/L） and the changes of artery blood glucose were observed in order to determine the risk factors of the hyperglycemia. [ Results ] No hypoglycemia and 25 cases of hyperglycemia were observed. The risk factors with hyperglycemia is age ≥ 65 yrs, pre-operation Glasgow coma scale score 〈 9, coma, exist hyperglycemia per-operation （P〈0.05）. Hyperglycemia correlates with the death during the period in hospital （OR 2.872 [95%CI： 1.160 - 7.112], P=0.023）. Mortality of the hyperglycemia patients during the operation was 40% higher thart that of non-hyperglycemia patients 19%, P=0.019. [Conclusion] The incidence of hyperglycemia during the decompressive craniectomy hematoma operation is 15%. The risk factors with hyperglycemia is age ≥ 65 yrs, pre-operation Glasgow Coma Scale score 〈 9, coma, exist hyperglycemia per-operation. Hyperglycemia during operation increases the mortality in hospital.