胰岛素强化治疗重型颅脑损伤合并糖尿病

目的探讨胰岛素强化治疗对重型颅脑损伤(STBI)合并糖尿病患者的临床疗效及预后的影响。方法选择入住重症监护病房(ICU)既往有糖尿病史的重型颅脑损伤患者80例,随机分为治疗组和对照组,每组40例,治疗组给予7 d胰岛素强化治疗,随后给予常规血糖控制,对照组全程常规血糖控制。强化胰岛素治疗组血糖控制目标为4.4~8.3 mmol/L,常规血糖控制目标为4.4~11.1 mmol/L。结果伤后随访6月按(GOS)评分评价疗效,治疗组恢复良好率较对照组组提高15%,死亡率下降17%(P0.05),ICU住院时间、机械通气时间、院内感染发生率均低于对照组(P0.05)。结论短期胰岛素强化治疗能有效改善重型颅脑损伤合并糖尿病患者的预后,降低ICU内并发症的发生率。     

强化胰岛素治疗在重型颅脑创伤救治中作用的荟萃分析

目的 评价强化胰岛素治疗(IIT)与常规胰岛素治疗(CIT)在重型创伤性脑损伤(sTBI)救治中的作用.方法 系统性检索中、外文文献数据库中的临床随机对照试验(RCT),使用Review Manager软件进行荟萃分析.评价指标包括:早期(住院期间)病死率、远期(3个月后)病死率、感染率、远期神经功能损伤量表(NSS)评分、低血糖事件发生率等.结果 共有12篇文献、共计1 277名患者纳入本项分析.早期病死率的合并OR =0.78 (95％ CI:0.53 ～ 1.15,P=0.21);晚期病死率的合并OR =0.85 (95％ CI:0.63 ～ 1.15,P=0.30);感染率的合并0R=0.49 (95％ CI:0.37～0.64,P＜0.00001);远期良好NSS比例的合并OR=1.62 (95％ CI:1.18 ～2.21,P=0.003);低血糖事件发生率的合并OR =4.33 (95％ CI:1.39 ～ 13.49,P=O.01)和2.61(95％ CI:2.27 ～2.99,P＜0.00001).结论 在sTBI救治中,与CIT相比,IIT对降低病死率无明显作用,但可降低患者感染率、改善远期神经功能,同时低血糖事件却明显增多.故IIT不太适合继续应用于救治重型颅脑创伤,进一步的证据还有待深入研究.     

颅脑外伤心电图改变的临床意义

目的 通过观察颅脑外伤患者心电图的变化,探讨心电图变化的意义.方法 观察168例颅脑外伤患者入院后心电图变化,并分组进行对比观察.所有患者均在住院期间监测心电图变化.结果 168例患者,80例为重度颅脑外伤;69(41.1%)例并发心电图异常.重度颅脑外伤组患者出现异常心电图的例数明显多于轻度颅脑外伤组(P＜0.01);心电图异常组出现死亡或者病情恶化的例数明显多于心电图正常组(P＜0.01).此外,22例死亡病例中16例(72.7%)显示心电图异常. 结论 颅脑外伤患者的心电图异常提示患者病情重,预后比较差.     

重度颅脑损伤并发应激性高血糖患者强化胰岛素治疗的监测与护理

目的 观察强化胰岛素治疗对重度颅脑损伤患者并发应激性高血糖的监测及护理.方法 对入住重症监护室治疗后,不同日期不同时间随机监测血糖连续2次或2次以上≥11.1 mmol/L 的患者,应用强化胰岛素治疗方案控制血糖.结果 56例重度颅脑损伤患者血糖控制效果满意,无低血糖发生.结论 该强化胰岛素治疗方案实用、简便易行,治疗时加强微量泵的应用管理、准确无误的胰岛素配制、严密的血糖监测,护士应用及患者的依从性是保证强化胰岛素治疗有效实施的关键,对改善重度颅脑损伤并高血糖患者的病情及预后、降低院内感染率、不增加低血糖的发生率、提高生存质量至关重要.     

应激性高血糖对急性重型颅脑损伤预后的评估

目的探讨血糖在急性重型颅脑损伤病情评估及预后判断的临床价值。方法对150例既往无糖尿病的急性颅脑损伤患者均于入院时进行GCS评分,根据GCS评分分为轻中度颅脑外伤组(GCS 9~15分)和重度颅脑外伤组(GCS 3~8分),并对患者48h内的血糖变化进行检测,探讨伤后血糖水平与患者伤情、预后的关系。结果重度颅脑损伤组患者的平均血糖水平高于轻中度组(P<0.05),血糖>11.1 mmol/L颅脑损伤患者的病死率明显高于血糖<11.1 mmol/L者(P<0.05),死亡患者的血糖水平明显高于存活患者(P<0.05)。结论重度颅脑外伤患者急性期的血糖浓度是判断颅脑损伤的严重程度及近期预后的参考指标,可作为GCS评分外的辅助指标。     

强化胰岛素治疗对脑出血后高血糖患者预后的临床观察

目的:观察强化胰岛素治疗对高血压脑出血后应激性血糖升高患者预后的影响。方法:207例无糖尿病史的高血压脑出血后血糖>6.7mmol/L的患者随机分为强化胰岛素治疗组(104例)和对照组(103例),经过3个月至半年随访,根据GOS预后评分观察强化胰岛素治疗组患者与对照组患者的预后。结果:比较两组患者预后,强化胰岛素治疗组恢复良好的患者增加,致残率下降,死亡率减少。两组比较有显著差异(P<0.01)。结论:应激性血糖升高能加重高血压脑出血后脑损害并使预后不良,应用强化胰岛素治疗可以明显改善伴有应激性血糖升高的高血压脑出血患者的预后。     

标准外伤大骨瓣开颅术与常规骨瓣开颅术治疗重型颅脑损伤对比研究

目的探讨标准外伤大骨瓣开颅术与常规骨瓣开颅术治疗重型颅脑损伤(STBI)的临床效果。方法 2014-02-2015-12我院74例STBI患者,随机数表法分为2组各37例。研究组采用标准外伤大骨瓣开颅术,对照组采用常规骨瓣开颅术,3个月后随访。对比治疗前后2组颅内压水平(ICP)及神经功能评分(NIHSS)变化情况,并统计对比2组预后情况及并发症发生情况。结果治疗前2组ICP水平及NIHSS评分对比差异无统计学意义(P0.05),治疗后2组各指标均较治疗前改善,且研究组ICP水平及NIHSS评分均低于对照组,差异有统计学意义(P0.05);研究组恢复良好率(59.46%)高于对照组(32.43%),差异有统计学意义(P0.05),2组中度残疾、重度残疾、植物生存及病死率对比,差异无统计学意义(P0.05);研究组并发症发生率(16.22%)低于对照组(37.85%),差异有统计学意义(P0.05)。结论标准外伤大骨瓣开颅术治疗重型颅脑损伤患者效果优于常规骨瓣开颅术,可有效降低颅内压,改善神经功能及预后效果,且安全性较高,具有推广价值。     

胰岛素强化治疗应用于ICU获得性肌无力的临床疗效观察

目的观察胰岛素强化治疗ICU获得性肌无力患者的临床疗效。方法 52例获得性肌无力患者随机分为对照组和研究组各26例。对照组给予常规胰岛素治疗,血糖控制在180~200mg/dl,研究组给予强化胰岛素治疗,血糖控制在80~110mg/dl,其余治疗同对照组。记录并比较2组原发疾病后第1、2、3月英国医学研究委员会(MRC)肌力评分、改良Barthel指数评分(BMI)及2组机械通气时间、ICU住院时间及总住院时间。结果研究组不同测量时间点MRC、BMI评分均高于对照组(P均0.05),机械通气时间、ICU住院时间及总住院时间均少于对照组(P均0.05)。结论强化胰岛素治疗可控制ICUAW的发生及发展,改善患者预后。     

高压氧联合标准外伤大骨瓣减压手术治疗重型颅脑外伤临床观察

目的 研究重型颅脑外伤患者接受高压氧联合标准外伤大骨瓣减压手术治疗的临床效果。方法 纳入菏泽市立医院收治的重型颅脑外伤患者76例为研究对象,采用随机数字表法分为2组,对照组38例,行单一标准外伤大骨瓣减压术治疗;实验组38例,于对照组治疗基础上,加以高压氧行综合治疗。比较2组综合疗效。结果 2组治疗前血尿指标、NIHSS评分、GCS评分比较,差异无统计学意义(P0.05);治疗后,2组血尿指标中尿L-FABP、GFAP、MBP、NSE表达水平及NIHSS评分均低于治疗前,TFPI-1、TFPI-1抗原表达水平及GCS评分均高于治疗前,差异有统计学意义(P0.05);实验组治疗后尿LFABP、GFAP、MBP、NSE表达水平及NIHSS评分均低于对照组,TFPI-1、TFPI-1抗原表达水平及GCS评分均高于对照组,差异有统计学意义(P0.05)。实验组意识恢复时间短于对照组,预后优于对照组,差异有统计学意义(P0.05)。结论 重型颅脑外伤患者予以标准外伤大骨瓣减压术联合高压氧治疗,有助于改善患者血尿指标水平,修复神经功能缺损,促进意识及早恢复,纠正意识障碍,有利于患者预后。     

精细化护理对重度颅脑外伤患者神经功能及活动能力的改善效果

目的探讨精细化护理对重度颅脑外伤患者神经功能及活动能力的改善效果。方法选取郑州大学第一附属医院2016-01—2017-12收治的重度颅脑外伤患者90例,随机分为对照组和观察组各45例,分别予以常规护理和精细化护理,比较2组干预后神经功能及活动能力改善情况。结果护理后,观察组神经功能缺损(NIHSS)评分改善程度明显优于对照组(P0.05);Fugl-Meye运动量表(FMA)评分和Barthel日常生活能力评价量表(BI)评分改善程度也明显优于对照组(P0.05)。结论临床对重度颅脑外伤患者实施精细化护理有助于促进患者神经功能恢复,提高活动能力。     

Intensive Insulin Therapy After Severe Traumatic Brain Injury: A Randomized Clinical Trial

Introduction  To investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic events defined as a glucose concentration less than 80 mg/dl (<4.44 mmol/l) in patients admitted to the intensive care unit (ICU) after severe traumatic brain injury (TBI). Methods and Results  Ninety-seven patients admitted after severe TBI, were enrolled and randomly assigned to two groups of target glycemia. Insulin was infused at conventional rates when blood glucose levels exceeded 220 mg/dl (12.22 mmol/l) or at intensive rates, to maintain glycemia at 80–120 mg/dl (4.44–6.66 mmol/l). The following primary and outcome variables were measured during follow-up: hypoglycemic episodes, duration of ICU stay, infection rate, and 6-month mortality and neurologic outcome measured using the Glasgow Outcome Scale (GOS). Episodes of hypoglycemia (defined as blood glucose <80 mg/dl or 4.44 mmol/l) were significantly higher in patients receiving intensive insulin therapy: median (min–max) conventional insulin therapy 7 (range 0–11) vs. intensive insulin therapy 15 (range 6–33); P<0.0001. Duration of ICU stay was shorter in patients receiving intensive insulin therapy (7.3 vs. 10.0 days; P < 0.05); while infection rates during ICU stay (25.0% vs. 38.8%, P = 0.15), and GOS scores and mortality at 6 months were similar in the two groups. Conclusions  Intensive insulin therapy significantly increases the risk of hypoglycemic episodes. Even though patients receiving intensive insulin therapy have shorter ICU stays and infection rates similar to those receiving conventional insulin therapy, both groups have similar follow-up mortality and neurologic outcome. Hence if intensive insulin therapy is to be used, great effort must be taken to avoid hypoglycemia. This work was done in the Department of Neuroanaesthesia, University of Rome “La Sapienza”, Rome, Italy, and was in part presented at the Euroanaesthesia 2006 meeting Madrid, Spain.     

强化胰岛素治疗对重型颅脑损伤患者预后的影响

目的探讨胰岛素强化治疗对重型颅脑损伤预后的影响。方法回顾性分析2006～2008年间我院收治的重型颅脑损伤伴血糖升高患者62例,其中32例进行强化胰岛素治疗,使血糖控制在4．4～6．1mmol／L,传统胰岛素治疗组30例患者血糖控制在11．1～14．0mmol／L。观察3个月后患者的格拉斯哥预后评分（GOS）。结果比较两组的GOS,强化胰岛素治疗组的恢复良好率高于传统胰岛素治疗组,而病死率低于后者,两组之间有显著差异（P〈0．05）。结论强化胰岛素治疗能改善重型颅脑损伤患者预后。     

重型颅脑损伤合并高血糖术后短期胰岛素强化治疗的效果分析

目的 探讨重型颅脑损伤（TBI）合并高血糖标准大骨瓣减压术后胰岛素强化治疗的效果。方法 2018年1月至2019年12月收治重型TBI合并高血糖66例,均行标准大骨瓣减压术治疗。术后按照随机数字表法随机分为观察组（胰岛素强化治疗）和对照组（胰岛素常规治疗）,每组33例。两组均给予胰岛素持续静脉泵入治疗1周,观察组空腹血糖控制在3.9~6.1 mmol/L,对照组控制在8~10 mmol/L。比较分析两组治疗前及治疗后1周胰岛β细胞功能指标[胰岛素敏感指数（ISI）、胰岛素抵抗指数（HOMA-IR）]、血清炎性因子[C-反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）]以及并发症。结果 治疗1周,两组ISI、HOMA-IR以及血清CRP、IL-6、IL-8、TNF-α水平均较治疗前均明显改善（P<0.05）;而且,观察组明显优于对照组（P<0.05）。观察组感染发生率（21.21%,7/33）明显低于对照组（54.55%,18/33;P<0.05）。结论 对重型TBI高血糖,术后短期胰岛素强化治疗有利于胰岛功能恢复,减轻炎性反应,降低感染发生率     

Aggressive Red Blood Cell Transfusion: No Association with Improved Outcomes for Victims of Isolated Traumatic Brain Injury

Background  Clinical studies have caused blood transfusion practices in critically ill patients to become more conservative in the last decade. However, few studies have focused on trauma patients, particularly those with severe isolated traumatic brain injury. Methods  We conducted a retrospective study to test the hypothesis that patients with severe brain injury would not benefit from aggressive red blood cell transfusion (RBCT). End points of the study were in-hospital mortality and morbidity (pneumonia, urinary tract infection, deep venous thrombosis, pulmonary embolus, decubitus ulcer, bacteremia, septic shock, myocardial infarction, and seizure). Included in our retrospective study were patients at two urban, level I trauma centers who were admitted with a diagnosis of isolated head injury and with a Glasgow Coma Scale (GCS) score of 8 or less. We recorded demographic, interventional, and outcome variables. Results  In 289 patients, 24 of 25 (96%) were transfused if their lowest recorded intensive care unit (ICU) hemoglobin level was 8.0 g/dl or less. In contrast, only 9/182 (5%) of these 289 patients were transfused if the hemoglobin levels were 10.0 g/dl or greater. In the remaining 82 patients with lowest ICU hemoglobin levels of 8.0–10.0 g/dl, 52% were transfused. These 82 patients (43 underwent RBCT and 39 did not) were included in our analysis. Discussion  The overall in-hospital mortality rate was 32%; rates were similar between the two groups (29%, non-RBCT; 35%, RBCT) (P = 0.64). Likewise, in-hospital morbidity was similar between groups. Logistic and proportional hazard regression analyses identified RBCT as one predictor of mortality. Conclusions  Our results suggest that a restrictive transfusion practice is safe for severely head-injured patients.     

不同强度降血糖对急性脑梗死后高血糖患者预后影响的研究

目的通过观察伴有卒中后高血糖的急性脑梗死患者,初步探讨强化降血糖与标准降血糖对其预后的影响。方法纳入106例发病72 h内的颈内动脉系统脑梗死患者,随机分为将末梢血糖控制在6~8 mmol/L的强化降血糖组及将末梢血糖控制在8~10 mmol/L的标准降血糖组,各53例,均予以胰岛素控制血糖达72 h。随访3 m,主要终点事件为:7 d NIHSS评分,3 m mRS评分;次要终点事件为:3 m死亡率,3 m严重残疾率,低血糖发生率。结果两组间7 d NIHSS评分与3 m mRS评分均具有显著统计学差异(P0.05)。但两组间3 m死亡率,3 m严重残疾率,低血糖发生率均无显著统计学差异(P0.05)。结论对急性脑梗死后高血糖患者强化降血糖较标准降血糖能显著改善神经功能缺损评分,对轻中度患者获益更明显,但减少死亡及改善严重残疾不明显。     

川东北地区脑出血患者急性期降压治疗现状调查研究

目的观察川东北地区高血压脑出血患者急性期降压治疗现状及其对院内病死率的影响。方法回顾性抽样2011-01—12在川东北地区部分医院住院发病24h内高血压脑出血患者,了解急性期降压治疗现状,降压治疗对脑出血患者院内病死率的影响。结果抽样调查起病24h内脑出血患者876例,血压升高者比例占93.2%,急性期内启动降压治疗率68.6%,超早期启动静脉降压13.2%。3级血压水平患者降压组病死率低于非降压组(P0.05),其中静脉降压组显著低于非静脉降压组(P0.01);启动降压≤24h和24h院内病死率亦差异有统计学意义(P0.05)。结论脑出血患者早期血压升高明显;川东北地区多数脑出血患者在急性期内启动降压治疗;降压治疗尤其合并超早期静脉降压可以降低3级血压水平患者的院内病死率。     

The significant impact of Coronavirus disease 2019 (COVID-19) on in-hospital mortality of elderly patients with moderate to severe traumatic brain injury: A retrospective observational study

Background Traumatic brain injury (TBI) is one of the main causes of death and disability among the elderly patient population. This study aimed to assess the predictors of in-hospital mortality of elderly patients with moderate to severe TBI who presented during the Coronavirus disease 2019 (COVID-19) pandemic.MethodsIn this retrospective analytical study, all elderly patients with moderate to severe TBI who were referred to our center between March 2nd, 2020 to August 1st, 2020 were investigated and compared against the TBI patients receiving treatment during the same time period within the year 2019. Patients were followed until discharge from the hospital or death. The demographic, clinical, radiological, and laboratory test data were evaluated. Data were analyzed using SPSS-21 software.FindingsIn this study, 359 elderly patients were evaluated (n = 162, Post-COVID-19). Fifty-four patients of the cohort had COVID-19 disease with a mortality rate was 33.3%. The patients with COVID-19 were 5.45 times more likely to expire before discharge (P < 0.001) than the TBI patients who were not COVID-19 positive. Other variables such as hypotension (OR, 4.57P < 0.001), hyperglycemia (OR, 2.39, P = 0.002), and use of anticoagulant drugs (OR, 2.41P = 0.001) were also associated with in-hospital death. According to the binary logistic regression analysis Age (OR, 1.72; 95% CI: 1.26–2.18; P = 0.033), Coronavirus infection (OR, 2.21; 95% CI: 1.83–2.92; P = 0.011) and Glasgow Coma Scale (GCS) (OR, 3.11; 95% CI: 2.12–4.53; P < 0.001) were independent risk factors correlated with increased risk of in-hospital mortality of elderly patients with moderate to severe TBI.ConclusionOur results showed that Coronavirus infection could increase the risk of in-hospital mortality of elderly patients with moderate to severe TBI significantly.     

强化胰岛素疗法在脑卒中治疗中的作用:Meta分析

目的评价强化胰岛素疗法在脑卒中救治中的作用。方法系统检索中、外文文献数据库临床随机对照试验后行meta分析。评价病死率、远期神经功能评分、低血糖事件发生率等。结果共纳入文献11篇。病死率合并OR=0.85(95%CI0.53,1.36;P=0.50);远期神经功能评分合并OR=1.00(95%CI0.78,1.29;P=0.99);低血糖事件发生率合并OR=7.81(95%CI5.17,11.80;P<0.00001)。结论脑卒中救治中,强化胰岛素疗法在病死率和远期神经功能方面,与常规胰岛素疗法无明显差别,但低血糖事件发生率却明显增多。