血糖水平与颅脑损伤时病情和预后的关系

目的 分析颅脑损伤患者的血糖水平与病情和预后的关系，指导临床治疗和预后判断。方法 按照格拉斯哥昏迷量表（GCS）评分将86例颅脑损伤患者分为轻型16例、中型24例和重型46例，分别在受伤后48h内、伤后1周、1个月和2个月对血糖进行检测，并结合损伤部位和残疾分级量表（DRS）对结果进行分析。结果 轻型颅脑损伤的血糖水平与对照组无显著性差异，中、重型患者受伤时血糖水平高，重型颅脑损伤时高血糖水平可持续2个月以上。DRS评分与伤后48h和伤后2个月时的血糖水平存在直线正相关，受伤后血糖水平越高，则残疾程度越重，预后越差。在中、重型颅脑损伤时，颅内损伤广泛并累及脑干功能和基底节区出血破入脑室的患者中血糖水平高且持续时间长。结论 颅脑损伤早期因应激反应出现高血糖，血糖水平可对病情和预后判断提供帮助。受伤时血糖水平高且持续时间长提示病情严重、预后欠佳。

Study on the correlation between blood glucose levels and severity/prognosis of traumatic brain injury

Objective To analyse the relationship between hyperglycemia and severity/prognosis after brain injury, and to provide evidences for clinical treatment and prognosis.Methods86 cases were divided into light (16 cases), moderate (24 cases) and severe (46 cases) injury groups based on Glasgow Coma Scale scores (GCS). The blood glucose was examined 48 hours, 1 week, 1 month and 2 months after injury. The results were analyzed according to the location/position of injury and the disability rating scale (DRS).ResultsThe blood glucose level in light injury group was normal. The blood glucose levels in moderate and severe injury groups rised more significantly than those did in light injury group. The hyperglycemia in severe injury group persisted over 2 months. There was positive linear relativity relationship between the DRS and the blood glucose levels 48 hours and 2 months after injury. The higher the blood glucose level was, the more the severity of the disability was and the worse the prognosis was. The blood glucose level was higher in the patients with abroad injury following brainstem dysfunction and/or blood breaking into ventricle, even persisting over a few months. ConclusionEarly hyperglycemia is a frequent phenomenon of the stress response to head injury, a significant indicator of its severity, and a reliable predictor of outcome.