重度颅脑损伤患者血糖血钠浓度与预后关系的研究

目的 :探讨重度颅脑损伤者的血糖、血钠浓度变化情况及其与预后的关系。方法 :对 2 0 0 0年 1月～ 2 0 0 2年 1 2月2 0 8例重度颅脑损伤患者的血钠、血糖进行监测。将伤后 2 4 h、72 h及 1周后的血钠、血糖的变化及其病情变化进行对比分析。结果 :重度颅脑损伤后低钠发生率高于高钠 (P<0 .0 5 ) ,一周后出现高血钠症患者的死亡率明显高于未出现高血钠症者 (P<0 .0 1 ) ;血糖难以控制的患者死亡率明显高于能够被控制者 (P<0 .0 1 ) ;高糖与高血钠症并存者死亡率高 (90 % )。血钠浓度改变及血糖升高的发生率 2 4 h与一周后无显著差异。结论 :重度颅脑损伤患者钠代谢失衡及血糖升高与脑损伤本身病理机制有关 ;及时手术、降低颅内高压、控制脑损害、有效控制一周后的高钠血症、高血糖及其高钠血症、高血糖并存是提高生存率的关键

The clinical study of the changes of blood glucose and natrium and prognosis of the serious brain injuries

Objective:To probe into the characteristics of the changes of blood glucose and natrium in the serious brain injuries and the prognosis of them Methods:The blood glucose and natrium in 208 cases with serious brain injury who were admitted in from Jan.2000 to Dec.2002 were detected.The changes of blood glucose and natrium at 24 hour,72 hour,1 week were analyzed,and also analysed the injury characteristic which interfered with the prognosis Results:The rate of hyponatremia was higher than hypernatremia in serious brain injuries( P <0 05),the mortality was higher in the hypernatremia patients than in normal natrium patients( P <0 01)after 1 week,the mortality was higher in the patients whose hypernatremia could not be cured than those symptom could be cured;the prognosis would be worse if the hypernatremia accompanied with hyperglycosemia.The change of blood natrium and the rate of hyperglycosemia were no significant difference between at 24 hour and 1 week Conclusion:The natrium decompensation and hyperglycosemia of the serious brain injuries are related to the injury itself;the survive rate would be improved if patients are operated in time to reduce intracranial press and the lesion of brain tissue,and if the hypernatremia,hyperglycosemia or hypernatremia accompanied with hyperglycosemia could be controlled