CAJ | 학술논문

目的动态监测颅脑创伤患者入院后3 d内血糖变化,评估高血糖对患者预后的影响.方法以伤后6 h入院、既往无糖尿病病史、无严重的合并伤为入选标准选取2007至2008年间颅脑创伤患者62例,监测入院后四个时间点(入院即刻、24 h,48 h,72 h)的静脉血糖值.按GCS(GlasgowComa Scale)分为轻、中、重型颅脑创伤三组,按预后分为死亡组与存活组,以入院血糖11.1 mmol/L为界分为严重高血糖组与轻度高血糖组,用t检验,χ2检验进行组间比较评估高血糖与患者伤情、预后的关系.结果轻、中、重型颅脑伤患者出现不同程度的高血糖,平均血糖随着伤情的加重依次升高;死亡组患者各时间点血糖水平均显著高于存活组,且以入院即刻差异最大[(8.51±2.01)mmol/Lvs.(11.54±2.45)rmnol/L,P=0.0001,t=4.988];严重高血糖组死亡率为64.71%,显著高于轻度高血糖组的13.95%(P=0.0002,χ2=15.46),两组的ICU平均住院天数(ICULOS)分别为22.6 d和10.2 d,差异具统计学意义(P=0.021,t=3.216),而总住院天数(HLOS)的差异无统计学意义(P=0.052).结论颅脑创伤后早期出现的应激件高血糖可反映伤情的严重程度,入院血糖>11.1mmol/L时将预示着患者的高死亡率,可作为早期预测预后的简易指标.
목적 동태감측로뇌창상환자입원후3 d내혈당변화,평고고혈당대환자예후적영향.방법 이상후6 h입원、기왕무당뇨병병사、무엄중적합병상위입선표준선취2007지2008년간로뇌창상환자62례,감측입원후사개시간점(입원즉각、24 h,48 h,72 h)적정맥혈당치.안GCS(GlasgowComa Scale)분위경、중、중형로뇌창상삼조,안예후분위사망조여존활조,이입원혈당11.1 mmol/L위계분위엄중고혈당조여경도고혈당조,용t검험,χ2검험진행조간비교평고고혈당여환자상정、예후적관계.결과 경、중、중형로뇌상환자출현불동정도적고혈당,평균혈당수착상정적가중의차승고;사망조환자각시간점혈당수평균현저고우존활조,차이입원즉각차이최대[(8.51±2.01)mmol/Lvs.(11.54±2.45)rmnol/L,P=0.0001,t=4.988];엄중고혈당조사망솔위64.71%,현저고우경도고혈당조적13.95%(P=0.0002,χ2=15.46),량조적ICU평균주원천수(ICULOS)분별위22.6 d화10.2 d,차이구통계학의의(P=0.021,t=3.216),이총주원천수(HLOS)적차이무통계학의의(P=0.052).결론 로뇌창상후조기출현적응격건고혈당가반영상정적엄중정도,입원혈당>11.1mmol/L시장예시착환자적고사망솔,가작위조기예측예후적간역지표.
Objective To dynamically monitor the blood glucose in traumatic brain injury (TBI) patients within three days after admission, and to assess the impact of hyperglycemia on prognosis. Method Between 2007 and 2008, 62 TBI patients, who were admitted within 6 hours after the ineidence of injury without diahetes or severe combined injuries, were involved in this study. Blood glucose was monitored at 4 time points (instantly, 24 hours, 48 hours, and 72 hours after admission). Patients were classified into the mild, the moderate, or the se-vere TBI group according to GCS (Glasgow Coma Scale) scores, being classified into the survival or the dead group according to prognosis, or into the mile or severe hyperglycemia group depending on whether the blood glucose ex-ceeds 11.1mmol/L on admission. T tests and χ2 tests were applied to analyze the relationship among blood glucose levels, the degrees of injury, and the prognosis of studied patients. Results Patients with mild, moderate, or se-vere TBI showed hyperglycemia with different levels, and the blood glucose levels was consistent with the degree of the injury. The blood glucose of the patients in the dead group were significantly higher at all checked time points than those of the survival group, particularly instantly after admission (8.51±2.01 mmol/L vs. 11.54±2.45 mmol/L, P=0.0001, t=4.988). The mortality of patients with severe hyperglycemia was 64.71%, signifl-candy higher than that of the mild hyperglycemia group 13.95% (P=0.0002, χ2=15.46). The Intensive Care Unit Length of Stay (ICULOS) of the above two groups was 22.6 and 10.2 days,respectively (P=0.021, t= 3.216), but their hospital length of stay (HLOS) showed no statistical difference (P=0.052). Conclusions Hyperglycemia, as an early stress response to TBI, may reflect the degree of the injury. Blood glucose levels that exceed 11.1 mmol/L on admission may imply high mortality of TBI patients, so this could be used as a simple indi-cator to predict prognosis.