颅骨骨折患者围术期高血糖和胰岛素抵抗相关分析

Correlation analysis of perioperative hyperglycemia and insulin resistance in patients with skull fracture

目的探讨颅骨骨折患者围术期高血糖和胰岛素抵抗相关性。方法对2018年1~12月在我院诊断治疗的粉碎性颅骨骨折患者28例的临床资料进行回顾性分析,术前根据GCS评分进行分组,13~15分为轻度组(7例),9~12分为中度组(12例),≤8分为重度组(9例)。比较三组患者围手术期血糖、胰岛素、胰岛素抵抗指数。分析患者围手术期血糖水平与胰岛素抵抗的相关性。结果轻度组围手术期血糖、胰岛素抵抗指数波动不明显,中度组与重度组在诱导后血糖、胰岛素抵抗指数逐渐上升,术毕逐渐下降,且重度组波动更显著(P<0.05)。轻度组围手术期胰岛素水平波动不明显,中度组与重度组在诱导后胰岛素水平逐渐下降,术毕逐渐上升,且重度组波动更显著(P<0.05)。患者围手术期血糖水平与胰岛素抵抗呈正相关(r=0.759)。结论中度及重度颅骨骨折患者围术期血糖水平及胰岛素抵抗指数波动明显,患者血糖水平升高与胰岛素抵抗密切相关,临床上,对于中重度颅骨骨折的患者应密切观察其血糖水平,避免相关并发症的发生。

Objective To investigate the correlation between perioperative hyperglycemia and insulin resistance in patients with skull fracture. Methods The clinical data of 28 patients with comminuted skull fracture diagnosed and treated in our hospital from January to December in 2018 were retrospectively analyzed. They were grouped according to the GCS scores before operation. The patients with 13-15 scores were set as mild group(7 cases), and those with 9-12 scores were included in the moderate group(12 cases) and those with≤ 8 scores were enrolled in the severe group(9 cases).The perioperative blood glucose, insulin, and insulin resistance index among three groups were compared. The correlation between perioperative blood glucose levels and insulin resistance was analyzed. Results The fluctuation of blood glucose and insulin resistance index in the mild group was not obvious. The blood glucose and insulin resistance index of the moderate group and the severe group gradually increased after induction, and gradually decreased after the operation, and the fluctuation of the severe group was more significant(P<0.05). The perioperative insulin fluctuations in the mild group were not obvious. In the moderate group and the severe group, the insulin gradually decreased after induction, and gradually increased in the surgery, and the fluctuation in the severe group was more significant(P<0.05). The perioperative blood glucose level was positively correlated with insulin resistance(r=0.759). Conclusion The perioperative blood glucose level and insulin resistance index of patients with moderate and severe skull fractures fluctuate significantly. The increase of blood glucose level is closely related to insulin resistance. Clinically, blood glucose levels in patients with moderate to severe skull fracture should be closely observed, to avoid the occurrence of related concurrency.