重度颅脑损伤后血糖变化与预后的关系

目的:探讨重度颅脑损伤后血糖升高与病情及预后的关系。方法:对我院213例重度颅脑损伤病人入院后72小时测定的空腹血糖进行回顾性分析,比较高血糖组(>6.10 mmol/l)与正常血糖组的Glasgow out-come scale(GOS)评定,同时也比较了不同Glasgow coma scale(GCS)水平的血糖水平与预后的关系。结果:高血糖组GOS良好率(24.7%)低于正常血糖组(37.9%),而死亡率(41.5%)高于正常血糖组(23.3%),GCS3~5分组中血糖值在(10.3±5.2)明显高于GCS6±8分组(9.0±2.2)且GCS3~5分组中高血糖(>15 mmol/l)组中死亡率为58.0%,明显高于其他分组,以上数据经统计学处理差异均有显著性(P<0.05)。结论:重度颅脑损伤病人早期因应激反应易出现血糖升高,同时伤情越重血糖越高,预后也越差。

The relationship between serum g lucos levels and prognosis in patients with severe head injury

Objective: To study the elationship between serum g lucos levels and neurologiccal prognosis in the patients with severe head injury. Methods: The empty abdomen serum glucosis levels of 213 patients with severe head injury (GCS<8) within 72 hours after admission were retrospectively analyzed to compare not only the good outcome rate and mortality (GOS) in the hyperglycemia group ( glucose value >6.10mmol/L) with those in normoglucemia group, but also the glucose levels of different GCS in the hyperglucemia group. Results: The good outcome rate was lower in the hyperglycemia group (24.7%) than in normoglucemia group (37.9%) (P<0.05), but the mortality was higher in the hyperglycemia group (41.5%) than in the normoglycemia group (23.3%) (P<0.05). The glucose levels were significantly higher in GCS 3～5 group (10.30±5.20 mmol/L) than in GCS 6～8 group (9.0±(2.2 mmol/L)) (P<0.05). Farther analyze showed the mortality in GCS 3～5 group (58.0%)was higher in the hyperglycemia group (P<0.05). Conclusion: Patients with severe head injury mostly develop serum glucose levels due to such factors as stress or brain stem and hypothalamus injuries. The severer head injury , the higher glucose levels and poorer neurological prognosis. Hyperglycemia was one of the major factors resulting in deaths of the patients with severe head injury.