应激性高血糖联合早期血乳酸清除率对重型颅脑外伤患者预后的临床意义

Clinical significance of stress hyperglycemia combined with early blood lactate clearance rate in the prognosis of patients with severe traumatic brain injury

目的探究应激性高血糖(stress-induced hyperglycemia,SIH)联合早期血乳酸清除率(lactate clearance rate,LCR)对重型颅脑外伤(severe traumatic brain injury,TBI)患者预后的临床意义。方法收集重型TBI患者81例的临床资料,根据28 d内生存情况分为预后良好组、预后不良组。比较2组患者的一般资料、SIH发生情况及早期LCR,采用Logistic回归分析重型TBI患者预后不良的影响因素,并根据ROC曲线分析SIH联合早期LCR对患者预后的临床价值。结果81例重型TBI患者,28 d内生存36例,死亡45例,病死率为55.56%。预后不良组格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、血氧饱和度、早期LCR低于预后良好组,脑疝发生率、SIH发生率、持续昏迷时间高于预后良好组(P<0.05)。经Logistic回归分析,GCS评分、脑疝发生情况、SIH、血氧饱和度、持续昏迷时间、早期LCR为重型TBI患者预后不良的危险因素(P<0.05)。ROC分析显示,早期LCR预测重型TBI患者预后的AUC值为0.764,SIH预测重型TBI患者预后的AUC值为0.761,联合预测的AUC值为0.900,联合预测的AUC值高于早期LCR、SIH单独预测。结论SIH、早期LCR与重型TBI患者预后关系密切,二者联合对预测患者预后具有一定临床价值。

Objective To explore the clinical significance of stress-induced hyperglycemia(SIH)combined with early lactate clearance rate(LCR)in the prognosis of patients with severe traumatic brain injury(TBI).Methods Clinical data of 81 severe TBI patients were collected and divided into good prognosis group and poor prognosis group according to the survival within 28 d.The general data,occurrence of SIH and early LCR of the two groups were compared.The influencing factors of poor prognosis of severe TBI patients were analyzed by Logistic regression analysis,and the clinical value of SIH combined with early LCR for prognosis of patients was analyzed according to receiver operating characteristic(ROC)curve.Results Among 81 severe TBI patients,36 survived and 45 died within 28 d,with a fatality rate of 55.56%.The Glasgow coma scale(GCS)score,blood oxygen saturation and early LCR in the poor prognosis group were lower than those in the good prognosis group,while the incidence of cerebral hernia,the incidence of SIH and the duration of coma were higher than those in the good prognosis group(P<0.05).Logistic regression analysis showed that GCS score,cerebral hernia occurrence,SIH,blood oxygen saturation,duration of coma,and early LCR were risk factors for poor prognosis in severe TBI patients(P<0.05).ROC analysis showed that the area under the ROC curve(AUC)of early LCR in predicting the prognosis of severe TBI patients was 0.764,and that of SIH in predicting the prognosis of severe TBI patients was 0.761.The AUC of the combined detection in prediction was 0.900,which was higher than that of the early LCR or SIH alone.Conclusion SIH and early LCR are closely related to the prognosis of severe TBI patients,and their combination has certain clinical value in predicting the prognosis of patients.