神经重症患者血糖水平与GCS及预后的相关性分析

Correlation between blood glucose level and GCS and prognosis in patients with severe neurological diseases

目的分析无糖尿病史神经重症患者血糖水平与预后的相关性。方法对2016年5月至2017年4月陆军总医院NSICU收治的539例既往无糖尿病史的神经重症患者进行分析,按指血糖值分为应激性高血糖(SHG)组(127例)和血糖正常组(338例),将SHG组随机分为常规治疗组(64例)和强化治疗组(63例)。分析血糖水平与GCS评分、GOS评分、28d病死率、机械通气时间、住ICU时间的相关性。结果 SHG组GCS评分更低(6.08±1.71,P=0.000),将SHG患者随机分为强化治疗组与常规治疗组后,两者相比,GOS评分无明显差异(P=0.507),住ICU时间(P=0.072)及28d病死率无差异(P=0.52),强化治疗组机械通气时间明显低于常规治疗组(P=0.009),差异有统计学意义。结论神经重症患者强化血糖控制可改善短期结局(机械通气时间),但对长期临床结局无影响。

Objective To analyse the correlation between the blood glucose level and prognosis in nondiabetes patients with severe neurological diseases.Method Data were analyzed retrospectively from May 2016 to April 2017 from non-diabetes patients with severe neurological diseases in NSICU of Army General Hospital,those patients were divided into stress hyperglycemia(SHG)group(127 cases)and normal glucose group(338 cases)according to the blood glucose level,SHG group were randomly divided into conventional treatment group(64 cases)and intensive treatment group(63 cases).The correlation between blood glucose level and GCS score,GOS score,28 day mortality,mechanical ventilation time and ICU time were analysed.Results SHG group has lower GCS scores.After the SHG group was divided into conventional treatment group and intensive treatment group,no significant difference was found in GOS score between the two groups(P=0.507),and there are no significant difference in ICU stay time(P=0.072)and 28 day mortality between the two groups(P=0.52),but mechanical ventilation time of intensive treatment group was significantly shorter than the conventional treatment group(P=0.009).Conclusion Intensive blood glucose control can improve short time clinical outcome in patients with severe neurological diseases such as mechanical ventilation time,but cannot improve the long time prognosis.