不同水平控制应激性高血糖对重型颅脑损伤患者预后的影响

Influence of stress hyperglycemia controlled in different levels on prognosis in patients with severe craniocerebral injury

目的 了解颅脑损伤后血糖的变化规律以及控制血糖对颅脑损伤预后的影响。方法 选取2013年1月-2015年1月在本院就诊的156例重型颅脑损伤患者作为研究对象,入院后立即对其进行血糖监测,并随机将其分为A组（n=88）和B组（n=68）。A组给予强化胰岛素治疗,微泵泵入胰岛素,且将血糖控制在5.0-8.0 mmol/L。B组给予常规胰岛素治疗,同时将血糖控制在8.1-11.1 mmol/L。两组的胰岛素治疗持续至血糖降到目标水平为止,根据血糖控制的目标值不同,了解两组的预后差异。结果 患者颅脑损伤程度越严重,血糖越高。A组预后明显优于B组,差异有统计学意义（P〈0.05）。A组院内感染发生率显著低于B组（P〈0.05）,但两组低血糖发生率差异无统计学意义（P〉0.05）。A组ICU住院时间为（9.2±1.2）d,显著短于B组的（17.5±3.6）d（P〈0.05）。结论 颅脑损伤后血糖水平高低是判断颅脑损伤严重程度的一个指标,通过严格控制血糖可改善患者的预后,而将血糖控制在5.0-8.0 mmol/L获益最大。

Objective To known the change rules of blood glucose after craniocerebral injury and influence of blood glucose control on prognosis of craniocerebral injury. Methods 156 patients with severe craniocerebral injuries admitted into our hospital from January 2013 to January 2015 were selected as research object.After admission,blood sugar monitoring was immediately used to all patients,and they were randomly divided into group A（n=88） and group B（n=68）.The group A was given intensive insulin therapy,and blood glucose level was controlled from 5.0 to 8.0 mmol/L by insulin in micropump.In group B,conventional insulin therapy was given,at the same time blood glucose level was limited from 8.1 to 11.1 mmol/L.The insulin therapy in two groups continued until blood glucose down to target levels.Based on different targeted values of blood glucose control.Prognosis of differences in two groups was understood. Results The more severe the craniocerebral injury,the higher the blood glucose became.The prognosis in group A was better than that in group B with a statistical difference（P〈0.05）. The incidence of nosocomial infection in group A significantly lower than that of group B（P〈0.05）,but there was no significant difference in the incidence of hypoglycemia between two groups（P〉0.05）.ICU hospitalization time in group A was（9.2±1.2） d,which was significantly shorter than that of group B[（17.5 ±3.6） d]（P 0.05）. Conclusion The high/low level of blood glucose after craniocerebral injury is an indicator to judge the severity of trauma.Patient′s prognosis can be improved by strictly controlling blood glucose,and blood glucose level between 5.0 mmol/L to 8.0 mmol/L benefits most.