急性重型颅脑损伤患者血糖水平对预后的影响

The effect of blood glucose levels on the prognosis of acute severe traumatic brain injury patients

目的探讨急性重型颅脑损伤患者不同血糖水平与患者预后的关系。方法回顾性分析武汉大学附属同仁医院（武汉市第三医院）神经外科2014年6月至2017年6月120例急性重型颅脑损伤患者的临床资料，依据入院格拉斯哥昏迷评分（GCS）分为重型颅脑损伤组及特重型颅脑损伤组，分析患者入院时、术后第1、3、7及14天血糖变化水平与预后情况。另外依据患者入院时血糖水平分为正常血糖组，血糖值6.1-10.0 mmol/L组，血糖值〉10 mmol/L组，采用出院3个月后的格拉斯哥结果评分（GOS）评估患者的预后，分析不同血糖组患者血糖水平与GOS评分的关系。结果特重型颅脑损伤组血糖水平高于重型颅脑损伤组，差异有统计学意义（P〈0.05）。重型颅脑损伤组GOS评分预后良好54例，预后不良16例，预后良好率为77.1%；特重型颅脑损伤组预后良好28例，预后不良22例，预后良好率为56%，2组比较差异有统计学意义（χ2=6.025，P=0.014）。正常血糖组患者预后良好23例，预后不良4例，预后良好率为85.2%（23/27）；血糖6.1-10.0 mmol/L组患者预后良好30例，预后不良8例，预后良好率为78.9%（30/38）；血糖〉10 mmol/L组预后良好31例，预后不良24例，预后良好率为56.4%（31/55）。随着入院血糖升高，患者预后良好率下降而预后不良率升高，差异有统计学意义（χ2=9.283，P=0.010）。结论急性重型颅脑损伤患者血糖水平与患者不良预后有关，高血糖严重影响重型颅脑损伤患者的预后，但血糖控制水平仍需进一步研究。

ObjectiveTo explore the relationship between different blood glucose levels and prognosis in patients with acute severe craniocerebral injury.MethodsClinical data of 120 patients with acute severe craniocerebral injury from Jun. 2014 to Jun. 2017 in Department of Neurosurgery, Tongren Hospital of Wuhan University were analyzed retrospectively. The patients were divided into the group of acute severe craniocerebral injury and the group of acute extra-severe craniocerebral injury according to the Glasgow coma score （GCS） . Blood glucose levels were detected at the time of admission, the 1st day, the 3rd day, the 7th day and the 14th day after operation. According to the blood glucose levels on admission, the patients were divided into the normal blood glucose group, the blood glucose value of 6.1-10.0 mmol/L group, the blood glucose value 〉 10.0 mmol/L group. The prognosis was evaluated by Glasgow Outcome Score （GOS） 3 months after discharge. The relationship between the blood glucose levels and GOS score in different groups was analyzed.ResultsThe blood glucose levels in the group of acute extra-severe craniocerebral injury were higher than those in the group of acute severe craniocerebral injury, and the difference was statistically significant （P〈0.05） . Of the patients with acute severe craniocerebral injury, 54 had good prognosis, and 16 had poor prognosis. Of the patients with acute extra-severe craniocerebral injury, 28 had good prognosis, and 22 had poor prognosis. The rate of good prognosis were 77.1% and 56% respectively, and the difference had statistical significance （P=0.014, χ2=6.025） . The good prognosis of patients with normal blood glucose group was 23 and the poor prognosis was 4, with a good prognosis rate of 85.2% （23/27） .Among patients with blood glucose of 6.1-10.0 mmol/L, 30 had good prognosis and 8 had poor prognosis, with a good prognosis rate of 78.9% （30/38） . Among patients with blood glucose 〉10.0 mmol/L, 31 had good prognosis and 24 had poor prognosis, with a good prognosis rate of 56.4% （31/55） . With the increase of blood glucose, the good prognosis rate gradually decreased and the poor prognosis rate gradually increased, and the difference was statistically significant （P=0.010, χ2=9.283） .ConclusionBlood glucose level has influence on the prognosis of patients with acute severe craniocerebral injury, and the good prognosis of patients with acute severe craniocerebral injury is severely affected by hyperglycemia.