重型颅脑创伤血糖变化对预后的影响及临床意义

Clinical significance of serum glucose assay in patients with severe head injury

为探讨血糖变化与颅脑创伤的意识障碍程度之间的关系，以及对预后的影响及临床意义，测定了５２例重型颅脑创伤的血糖变化及颅脑损伤的动物血糖，按格拉斯哥昏迷计分（ＧＣＳ）将患者入院时分为３组：Ⅰ组ＧＣＳ３～４分，Ⅱ组ＧＣＳ５～６分，Ⅲ组ＧＣＳ７～８分，同时设Ⅳ为对照组；实验用ＳＤ大白鼠３０只，分颅脑创伤轻、重组及对照组。结果：重型颅脑创伤入院时ＧＣＳ３组病人及Ⅳ组对照，测定血糖分别为１４８２±３４５、１０３２±０６５、７９０±０４９、５４２±０６２ｍｍｏｌ／Ｌ。各组间及对照组之间血糖值有显著差异（Ｐ＜００１）；实验动物颅脑创伤轻、重伤组及对照组术后１ｈ、３ｈ、７ｈ血糖有显著差异（Ｐ＜００１）；５２例病人经治疗后存活２９例，血糖７３８±１５９ｍｍｏｌ／Ｌ，其中２４例血糖＜１０ｍｍｏｌ／Ｌ；死亡２３例，血糖２３０２±３１２ｍｍｏｌ／Ｌ，其中２１例血糖≥１０ｍｍｏｌ／Ｌ。表明血糖＞１０ｍｍｏｌ／Ｌ，死亡率增高（Ｐ＜００１）。结论：重型颅脑创伤后，血糖因意识障碍加重而升高，当病情改善后血糖也随之下降，血糖持续升高易致死亡率增加，因而应注意降血糖治疗，测定血糖变化有助于判断颅脑创伤病情。

In order to investigate the relationship between serum glucose level and degree of unconciousness in patients with severe head injury and the role of serum glucose in trauma prediction, serum glucose was assayed in 52 patients with severe head injury and 30 SD rats with head injury. The patients were divided into three groups and 15 normal people were included as control group. The animals were randomly divided into sligthtly injured group, severely injured group and control group. The results showed that the average levels of serum glucose in patients on admission were 14.82%±3.46 mmol/L, 10.32±0.65mmol/L, 7.9±0.49 mmol/L and 5.42±0.62 mmol/L in groups Ⅰ,Ⅱ,Ⅲ and Ⅳ, respectively. The differences between the groups were significant (P<0.01). There were significant differences in serum glucose levels between injured and control rat groups 1 h, 3 h and 7 h after operation. Of 52 patients 29 patients survived and 23 died. The serum glucose levels were 7.38±1.59 mmol/L in survivors and 23.02±3.12 mmol/L in the dead. It is concluded that serum glucose increases with deepening of unconciousness and decreases with improvement of patient′s condition; a continuing increase in serum glucose indicates a high mortality. Therefore, reduction of serum glucose is important in treatment of patients with head injury. Examination of serum glucose is helpful in diagnosis and prognosis of head injury.