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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。
Objective To investigate the correlation between the changes of perioperative blood glucose and the degree of brain injury in patients with acute traumatic brain injury. Methods The clinical data of 125 patients with acute traumatic brain injury who meet the research criteria were retrospectively analyzed from July 2012 to June 2015 in the Department of Neurosurgery, the First Affiliated Hospital of China Medical University. According to the clinical data of patients admitted to hospital (GCS 15 points), light (GCS 13 to 14), medium (GCS 9 to 12), heavy (GCS 6 to 8), and heavy-heavy (GCS 3 ~ 5). After admission, blood glucose control (including stress relieving factors and insulin application) was started. The daily blood glucose of patients after admission was counted, and the mean of blood glucose of each group was calculated at different time points. The standard deviation of blood glucose and coefficient of variation of blood glucose were analyzed. The relationship between the degree of glycemic variation and the duration of hyperglycemia in patients with craniocerebral injury was analyzed. Results In the same period, the mean blood glucose, standard deviation of blood glucose and the coefficient of variation of blood glucose were significantly higher in the special-heavy group and the heavy-duty group than those in the control group (P <0.05). In the same group, 48 h admission and 3 ~ 7 admission (P <0.05). The mean duration of hyperglycemia and the average duration of disturbance of consciousness in patients with severe and severe type were significantly different from those in patients with severe and severe type Compared with the control group, there was a significant difference (P <0.05). Rank correlation analysis showed that the overall level of blood glucose, blood glucose fluctuations and the average duration of hyperglycemia was positively correlated with the severity of traumatic brain injury (r> 1). Conclusion The level of blood glucose in patients with acute traumatic brain injury can be used as the evaluation index of the severity of severe traumatic brain injury.