重型脑损伤早期血糖变化与预后关系的临床研究

Clinical study on relationship between early blood glucose change and prognosis of severe brain injury

目的探讨危重脑损伤患者早期的血糖变化情况及预后。方法选取格拉斯哥昏迷评分(glasgow coma scale,GCS)≤8分32例重型脑损伤患者,根据随访结果分为生存组和死亡组。测量入院时随机血糖,入院后第1天、第2天、第3天、第5天同一时间晨起空腹抽血化验血糖、肝肾功、电解质、血常规等。每日早晚至少两次动脉血气分析变化情况。结果 (1)入院时,生存组患者GCS评分、谷丙转氨酶、谷草转氨酶、白蛋白、尿素、血清肌酐、pH值及动脉血二氧化碳分压与死亡组比较,差异均无统计学意义;两组年龄差异有统计学意义(t=-2.634,P=0.013)。(2)与死亡组比较,生存组患者入院时(t=-3.562,P=0.001)随机血糖值和入院后第1天(t=-2.716,P=0.011)的血糖值差异有统计学意义。(3)生存组内比较,5 d内的血糖值比较差异无统计学意义;死亡组内比较,血糖值在入院时明显偏高,经过降糖处理后虽然下降但随之又再次升高,呈不稳定性改变,其中入院后第2天(P=0.029)和入院后第3天(P=0.016)与入院时血糖值比较,差异有统计学意义。结论 (1)通过观察重症脑损伤患者血糖变化曲线能够及早调整相关治疗,有利于病情转归。(2)血糖的平稳调控对重症脑损伤患者的预后尤为重要。

Objective To explore the effect of blood glucose fluctuation on the prognosis of patients with severe brain injury. Methods 32 cases of patients with severe brain injury whose glasgow coma scale score≤8 points were selected. According to follow-up, 32 patients were divided into survival group and death group. Random blood glucose was examined at admission and blood samples were collected in the morning to detect the blood routine, liver and kidney function, levels of blood glucose and serum electrolytes on the first, second, third and fifth day after admission. Arterial blood gas analysis was also tested more than twice a day.Results （1） In term of levels of glutamic pyruvic transaminase, glutamic oxalacetic transaminase, urea, serum creatinine, pH and arterial blood CO2 partial pressure, there were no statistically significant differences between two groups; The age at admission showed statistically significant differences between two groups （t=-2.634,P=0.013）. （2） Levels of random blood glucose and blood glucose at the first day after admission showed statistically significant differences between two groups （t=-2.716,P=0.011）. （3） The level of blood glucose in survival group remained relatively stable at the fifth day and no statistically significant difference was detected within the survival group. In contrast, the level of blood glucose at admission was higher in death group, and decreased after treatment but increased on subsequent days,the levels of blood glucose on the second and third day （P=0.029,P=0.016） statistically significant differences detected within the death group.Conclusions （1） The blood glucose fluctuation of patients with severe brain injury can be used as a marker of disease prognosis to guide treatment adjustment, and be better for disease outcome. （2） It is important to stabilize blood glucose for better prognosis of patients with severe brain injury.