重型颅脑损伤后高血糖的临床意义分析

目的探讨重型颅脑损伤（SBI）后高血糖的临床意义。方法回顾性收集了128例重型闭合性颅脑损伤（GCS≤8分）患者的临床资料,应用统计学方法分析不同颅脑损伤损伤类型、入院时GCS水平、瞳孔光反应、近期预后与术后24小时内血糖水平的关系。颅脑损伤类型分为硬膜外血肿、硬膜下血肿、脑内血肿/脑挫裂伤3组;入院时GCS水平分成3-4分组、5-6分组、7-8分组;瞳孔对光反应情况分成双侧瞳孔光反应存在、单侧瞳孔光反应消失、双侧瞳孔光反应消失3组。近期预后分为预后良好和预后不良2组。结果重型颅脑损伤组血糖水平明显高于中型颅脑损伤组（P〈0.05）,3-4分组血糖水平（16.11±2.85）mmol/L明显高于7-8分组（12.33±2.23）mmol/L和5-6分组（14.11±2.85）mmol/L,而5-6分组血糖水平也明显高于7-8分组,各组间差异均有统计学意义（P〈0.05）;双侧瞳孔光反应消失组术后24小时内血糖水平（19.29±3.87）mmol/L,明显高于双侧瞳孔光反应存在组（15.69±2.83）mmol/L和单侧瞳孔光反应消失组（17.84±3.89）mmol/L,单侧瞳孔光反应消失组血糖水平明显高于双侧瞳孔光反应存在组,各组间差异均有统计学意义（P〈0.05）;预后不良组术后24小时内血糖水平明显高于预后良好组（P〈0.05）。血糖16.7mmol/L组的预后明显差于≤16.7mmol/L组（P〈0.05）。结论重型颅脑损伤后血糖水平明显增高。颅脑损伤伤情越重,血糖水平越高。高血糖是严重影响重型颅脑损伤预后的重要指标。

The clinical analysis of hyperglycemia in patients with severe traumatic brain injury

Objective To evaluate the clinical effet of hyperglycemia in the patients with severe traumatic brain injury.Methods 128 patients with severe traumatic brain injury（Glasgow Coma Scale,GCS ≤8） were retrospectively studied.The serum glucose levels,GCS,papillary reaction and neurological outcome of the patients were collected.According to the type of brain injury,the cases were divided into three groups：epidural hematoma,acute subdural hematoma,intracerebral hematoma/cerebral contusions.According to GCS score on admission,the patients were divide into 3 to 4 score group,5 to 6 score group,7 to 8 score group.And divide into bilaterally normal group,unilaterally absent group and bilaterally absent group according to pupillary reaction; And divide into favorable outcome group and unfavorable outcome group according to recent prognosis.Results Patients with severe brain injury had significantly higher serum glucose levels than those with moderate brain injury.The serum glucose level in GCS 3 -4 group was significantly higher than that in GCS 7 -8 group and 5 -6 group,and the level in GCS 5 -6 group was significantly higher than that in 7-8 group（P0.05）.In the same group of patients,a significant relationship was found between postoperative glucose levels and pupillary reaction.The serum glucose level in bilaterally absent group was significantly higher than that in bilaterally normal group and unilaterally absent group,the level in unilaterally absent group was significantly higher than that in bilaterally normal group（P〈0.05）Patients who subsequently had an unfavorable outcome had significantly higher glucose levels than those with a better prognosis.Glucose level greater than 16.7mmol/L had a worse outcome.Conclusion Patients with severe brain injury would frequently develop higher hyperglycemia.The brain injury was severer,the higher glucose level and the poorer the neurological prognosis.Hyperglycemia was one of the major factors impacting severe head injury outcome.