中、重型颅脑损伤病人血糖、血肌酐的变化对疾病转归的影响

Analysis of effects of changes in levels of blood glucose and serum creatinine on prognoses in patients with moderate and severe craniocerebral injury

目的探讨中、重型颅脑损伤病人血糖、血肌酐变化情况及其对病情转归的影响。方法回顾性分析2015年10月至2018年1月收治的71例中、重型颅脑损伤的临床资料。伤后24 h、48 h、72 h、7 d、14 d、30 d监测血糖及血肌酐。伤后1年,按GOS评分评估预后。结果伤后1年,预后良好23例(GOS评分4~5分,预后良好组),预后不良48例(GOS评分1~3分,预后不良组)。两组病人血糖、血肌酐均先增高,后降低,伤后7 d达峰值。伤后24 h至伤后30 d,预后良好组血糖水平均明显低于预后不良组(P<0.05)。伤后24 h,预后良好组血肌酐水平明显高于预后不良组(P<0.05);伤后48 h至伤后30 d,预后良好组血肌酐水平均明显低于预后不良组(P<0.05)。结论中、重型颅脑损伤病人血糖、血肌酐水平变化与病人预后显著相关,伤后血糖、血肌酐升高越明显,预后越差。

Objective To investigate the effects of changes in the levels of blood glucose and serum creatinine on the outcomes in the patients with moderate and severe head injury. Methods The retrospective analysis of the clinical data of 71 patients with moderate and severe craniocerebral injury treated in our hospital from October, 2015 to January, 2018 were made. The levels of their blood glucose and serum creatinine were determined 1, 2, 3, 7, 14 and 30 days after the injury. Of these 71 patients, 23 had good prognosis and 48 poor prognosis according to GOS 6 months after the injury.The relationships of the prognosis with the levels of blood glucose and serum creatinine were analyzed. Results The levels of blood glucose and serum creatinin were significantly lower in the patients with good prognosis than those in the patients with poor prognosis 2, 3, 7, 14 and 30 days after the injury(P<0.05). Of 23 patients with good prognosis 6 months after the injury, 20 were recovered well and 3 moderately disabled, and of 48 patients with poor prognosis 6 months after the injury, 3 were recovered well, 37 moderately disabled, 6 severely disabled and 2 died 1 year after the injury according to the GOS.There was significant difference in the rates of good prognoses between both the groups(P<0.05). Conclusion The levels of blood glucose and serum creatinine are closely related to the prognoses in the patients with moderate and severe craniocerebral injury.