中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2016, Vol. 45 ›› Issue (4): 313–317.doi: 10.12007/j.issn.0258-4646.2016.04.007

• 论著 • 上一篇    下一篇

急性创伤性颅脑损伤患者围手术期血糖变化与颅脑损伤严重程度的相关性

包义君 1,陶山伟 1,李力卓 2,3,张德威 1,王鹏飞 4,黄小龙 1,张文泰 1,赵丹 1,王运杰 1   

  1. 1 中国医科大学附属第一医院神经外科,沈阳 110001;2 中国医科大学附属盛京医院急诊科,沈阳 110004;3 海南医学院附属医院急 危重症医学部,海口 570102;4 河北北方学院第一附属医院神经外科,河北 张家口 075000
  • 收稿日期:2015-12-03 出版日期:2016-04-28 发布日期:2016-04-05
  • 作者简介:包义君(1975 -),男,副教授,博士.
  • 基金资助:
    教育部留学回国人员科研启动基金(教外司留[2013]1792 号);辽宁省自然科学基金(2015020460;2013021083);沈阳市科技创新专项基金人口与健康科技攻关专项(F13?220?9?53)

Correlation between the Glucose Variability and the Disease Severity in Patients with Acute Traumatic Brain Injury

BAO Yi-jun1,TAO Shan-wei1,LI Li-zhuo2,3,ZHANG De-wei1,WANG Peng-fei4,HUANG Xiao-long1,ZHANG Wen-tai1,ZHAO Dan1,WANG Yun-jie1   

  1. 1 Department of Neurosurgery,The First Hospital,China Medical University,Shenyang 110001,China;2 Emergency Department,Shengjing Hospital,China Medical University,Shenyang 110004,China;3 Department of Critical Care and Emergency Medicine,The Affiliated Hospital of Hainan Medical University,Haikou 570102,China;4 Department of Neurosurgery,The First Hospital of Hebei North University,Zhangjiakou 075000,China
  • Received:2015-12-03 Online:2016-04-28 Published:2016-04-05

摘要: 目的 探讨急性创伤性颅脑损伤患者围手术期血糖变化与颅脑损伤程度的相关性。方法 回顾性分析 2012 年 7 月至2015 年 6 月于中国医科大学附属第一医院神经外科住院治疗的 125 例满足研究标准的急性单发性创伤性颅脑损伤患者的临床资料,根据患者入院时的格拉斯哥昏迷评分(GCS)分组:对照组(GCS 15 分)、轻型组(GCS 13~14 分)、中型组(GCS 9~12 分)、重型组(GCS 6~8 分)和特重型组(GCS 3~5 分),入院后即开始进行血糖控制(包括缓解应激因素和应用胰岛素),分别统计患者入院后的每日血糖,然后计算各组在不同时间段内的血糖均数、血糖标准差及血糖变异系数,分析患者血糖变异度和高血糖的持续时间与患者颅脑损伤严重程度的关系。结果同一时间段特重型组和重型组的血糖均数、血糖标准差及血糖变异系数均明 显高于对照组(P < 0.05);同一组中,在入院时、入院 48 h 和入院 3~7 d 不同的时间段间,患者的血糖均数、血糖标准差和血糖变 异系数均有统计学差异(P < 0.05);特重型组和重型组患者高血糖平均持续时间和意识障碍平均持续时间与对照组相比均有统 计学差异(P < 0.05)。秩相关分析表明,血糖整体水平、血糖波动度以及高血糖平均持续时间与患者颅脑损伤严重程度呈正相 关(r >1)。结论 急性单发性创伤性颅脑损伤患者血糖变化水平可以作为重型颅脑损伤病情严重程度的评价指标。

关键词: 急性创伤性颅脑损伤, 血糖变异度, 高血糖持续时间

Abstract: Objective To explore the correlation between the glucose variability and the severity of acute isolated traumatic brain injury(TBI). Method According to the inclusion/exclusion criteria,a total of 125 cases of acute isolated TBI admitted in Department of Neurosurgery of China Medical University from July 2012 to June 2015 were included. According to Glasgow coma scale(GSC),the patients were divided into five groups including control(GCS 15),mild(GCS 13-14),moderate(GCS 9-12),severe(GCS 6-8),and extra-severe(GCS 3-5)groups. Blood glucose control(including relief of the stress and the application of insulin)were carried out immediately. The average,standard deviation,and variation coefficient of blood glucose of all groups were recorded at admission,48 hours and 3-7 days after hospitalization. The clinical records and glycemic index were compared among different groups and during different periods,so as to analyze the relationship of the variability of glucose and the duration of hyperglycemia with the severity of TBI and the effects of glycemic intensive care management. Results The Results of Kruskal Wallis test and Mann-Whitney U test showed that the average,standard deviation,and variation coefficient of glucose in the extra-severe group and the severe group were statistically higher than those in the control group(P < 0.05)during the same period. Meanwhile,the average,standard deviation,and variation coefficient of glucose at admission,48 hours and 3-7 days after hospitalization were also different among each group(P < 0.05). The duration of hyperglycemia and conscious disturbance in both the extra-severe group and the severe group were longer than those in the control(P < 0.05). The analyses using rank correlation indicated that glucose variability,the level and duration of hyperglycemia were positively correlated with the severity of TBI(r > 1). Conclusion The glucose variability in acute isolated TBI patients could be considered as the index of the severity of TBI.

Key words: acute isolated traumatic brain injury, glucose variability, the duration of hyperglycemia

中图分类号: 

  • R651.1
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