颅脑外伤后血糖的动态变化与伤情及预后相关性的研究

目的:探讨颅脑外伤(TBI)患者血糖动态变化与伤情及预后的相关性。方法:对71例中、重型TBI患者,于入院当时和入院后第2～7天空腹抽取静脉血,进行血糖测定,动态观察血糖的变化,并对临床患者的临床资料和治疗结果进行回顾总结,评估血糖动态变化与伤情和预后的相关性。结果:本组均为伤后12 h入院。71例患者中,A组中型伤者37例,B组重型伤者22例,C组特重型伤者12例。入院时A组、B组、C组患者的平均血糖值分别为(5.9±2.5)mmol/L、(8.9±2.1)mmol/L和(14.2±1.9)mmol/L,B组、C组明显增高,差异有统计学意义(P<0.01);伤后7 d内动态监测显示,B组伤后1～4 d内血糖值高于A组,而5～7 d内则无差异;C组伤后7 d内的血糖值,均明显高于A组、B组(P<0.01)。本组死亡18例,存活53例;死亡组伤后7 d内的血糖值,也明显高于存活组(P<0.01)。结论:中型、重型TBI患者伤后血糖均有程度不同的增高,血糖增高的程度和脑损伤的严重程度存在相关性,血糖明显增高者往往预后不良。

Study of relationship between dynamic changes of blood glucose and levels of brain injury and prognosis in patients with traumatic brain injury

Objective To investigate the relationship between the dynamic changes of blood glucose and levels of brain injury and prognosis in patients with traumatic brain injury(TBI).Method 71 consecutive cases with moderate and severe TBI were included in this study.The levels of blood glucose at admission and at every morning in fasting conditions of the following 6 days were measured.The clinical datas and results of these patients were reviewed respectively.And the relationship between the dynamic changes of blood glucose and levels of brain injury and prognosis was analyzed.Results All the patients were admitted to our hospital within 12 hours after trauma.According to the levels of brain injury on admission,these patients were classified as A group(37 cases with moderate TBI),B group(22 cases with severe TBI) and C group(12 cases with extremely severe TBI).The average values of blood glucose on admission were 5.9±2.5 mmocle,8.9±2.1 mmol / L and 14.2±1.9 mmol/L in A,B and C groups,and the increasing of blood glucose on admission in B group and C group was significantly compared with A groups(P<0.01).The dynamic measurements of blood glucose within the first 7 days after trauma showed that the values of blood glucose within the first 4 days after trauma in B group were higher than A group(P<0.01),but no statistic difference in the days of 5 to 7 day after trauma.And the increasing of blood glucose within the first 7 days in C group were also significantly compared to A and B groups during the same time periods(P<0.01).Among these 71 cases,18 patients were dead and 53 were survival.And the levels of blood glucose within the first 7 days in group of mortality were also significantly higher than that in survival group(P<0.01).Conclusion During the acute stage of moderate and severe TBI,there may be some extent increasing of blood glucose.And there is a relationship between the levels of increased blood glucose and brain injury.Significant increasing of blood glucose after trauma may be associated with poor prognosis in moderate and severe TBI.Dynamic monitoring of blood glucose changes after TBI may be contributed to the evaluation of brain injury and improvement of these patients.