严重创伤患者血糖和外周血象与MODS及感染的相关性研究

目的探讨严重创伤患者血糖与外周血象和多器官功能不全综合征(MODS)及感染之间的关系。方法随机抽查2002年12月至2004年12月本院创伤ICU患者病历1156份,根据住院期间血糖最高水平分为血糖正常组(≤6.1mmol/L)和血糖升高组(>6.1mmol/L)。统计不同血糖水平组的外周血象及MODS发生率和感染率。结果(1)1156例中血糖正常370例(32.01%),血糖升高786例(67.99%),严重创伤患者血糖升高百分率明显高于血糖正常百分率(P<0.01)。(2)血糖升高组外周血中性粒细胞和单核细胞均明显高于血糖正常组(P<0.01),而血红蛋白和血小板与血糖正常组无显著差别。(3)血糖正常组370例出现MODS 22例,MODS发生率为5.95%;血糖升高组786例出现MODS 254例,MODS发生率为32.32%,血糖升高组MODS发生率明显高于血糖正常组(P<0.01)。(4)血糖正常组370例发生感染56例,感染率为15.14%;血糖升高组786例发生感染463例,感染率为58.91%,血糖升高组感染率明显高于血糖正常组(P<0.01)。结论严重创伤高血糖反应与外周血白细胞、MODS、感染明显相关,血糖升高可作为创伤后MODS早期诊断指标,改善糖代谢障碍对预防和治疗创伤后感染及MODS有重要意义。

Correlative Study on Blood Glucose and Peripheral Hemogram with MODS and Infection in Severe Traumatic Patients

Objective To investigate the relationship among blood glucose,peripheral hemogram,MODS and infection in traumatic patients.Method A total of 1156 traumatic patients in ICU,selected randomly from our hospital during Dec.2002 and Dec.2004,were divided into the normal glucose group(≤6.1mmol/L) and hyperglycemia group(>6.1mmol/L).Peripheral blood cells and the incidences of MODS and infection were observed.Results(1)There were 370 cases of normal glucose(32.01%) and 786 cases of hyperglycemia(67.99%).The percent of hyperglycemia was significantly higher than that of normal glucose in severe traumatic patients(P<0.01).(2)The levels of neutrophil and monocyte in normal glucose group were significantly lower than that in hyperglycemia group(P<0.01),but the level of HGB or PLT was not different between two groups.(3)The incidence of MODS in normal glucose group was 5.95%(22/370),lower than that in hyperglycemia group(254/786,32.32%)(P<0.01).(4)The incidence of infection in normal glucose group was 15.14%(56/370),lower than that in hyperglycemia group(463/786,58.91%)(P<0.01).Conclusions Hyperglycemia is correlated with WBC,MODS and infection in severe traumatic patients.The increase of blood glucose may contribute to the early diagnosis of MODS caused by trauma.The amelioration of disorder of glucose metabolism is important to the prevention and treatment of MODS and infection caused by trauma.