颅脑损伤后24h内血糖值与伤情程度和预后的关系

目的探讨重度颅脑损伤后24h血糖与格拉斯哥昏迷评分(GCS)的关系及其对预后的影响。方法将81例重度颅脑损伤患者(GCS≤8分)分为两组:A组31例(GCS 3～5分),B组50例(GCS 6～8分);测定入院12h和24h内血糖,出院时根据GCS预后评分表(GOS)标准分为:预后良好组49例(C组,GOS 4～5级),预后较差组32例(D组,GOS 1～3级)。结果 A组伤后12h血糖均值为(10.87±3.94)mmol/L,B组为(6.43±2.30)mmol/L,A组伤后24h血糖均值为(14.46±2.83)mmol/L,B组为(8.53±3.01)mmol/L,差异有统计学意义(P<0.01),GCS评分愈低者血糖值愈高,持续时间愈长,两者呈负相关;C组伤后12h血糖均值为(6.37±2.51)mmol/L,D组为(10.73±3.76)mmol/L;C组伤后24h血糖均值为(8.76±2.12)mmol/L,D组为(14.32±2.54)mmol/L,差异有统计学意义(P<0.01),血糖值高者预后较差。结论颅脑损伤后血糖值越高,持续时间越长,则伤情越严重,预后越差,及时有效地控制血糖能提高救治成功率。

The relationship between blood glucose,injury severity and the prognosis within 24 hours of the craniocerebral injury

Objective To investigate the relationship between the blood glucose（BG） within 24 hours after the severe cranioeerebral injury and the GCS scores and its effect to the prognosis. Methods Retrospective reviews were performed on 81 patients of gravis type craniocerebral injury whose GCS score≤8. They were seperated into group A （GCS 3-5,31 patients ）and B（GCS 6-8,50 patients） randomly. Median cubical vein blood were taken to check the blood glucose within 24 hours on admission. The prognosis was divided into group C and D by GOS,according to the discharging conditions including satisfactory（C group：GOS 4-5） and dissatisfactory（D group： GOS 1- 3）. Results The BG value was higher than the normal reference value after the patients suffered from the craniocerebral injury. The comparison of the BG values was made between group A and B,and the differences was statistically significant （P〈0.01）. The lower the GCS scores were,the higher the BG values are admitted. The same comparison was made between group C and D,and the differences were statistically significant（P〈0.01）. The lower the GOS scores were, the higher the BG values were admitted. ConclusionThe higher the BG value in the acute phase of craniocerebral injury is,the more severe the patients＇ condition and the worse the prognosis would be. The therapeutic outcome will be en hanced if the hyperglycemia is controlled timely and effectively.