摘要
目的研究血糖水皮对创伤性重型、特重型颅脑损伤手术患者预后的影响。方法选取中国人民解放军联勤保障部队第九九〇医院2017-01—2019-06收治的创伤性重型、特重型颅脑损伤手术患者54例,根据28 d预后分为生存组(n=40)、死亡组(n=14)。分析患者入院72 h内平均血糖(GluAve)、血糖标准差(GluSD)、血糖变异系数(GluCV),比较组间差异。将GluAve、GluCV分为不同亚组,比较不同亚组见的病死率。结果死亡组GCS评分低于生存组,差异有统计学意义(P<0.05);生存组APACHEⅡ评分高于死亡组,差异有统计学意义(P<0.05)。生存组GluAve、GluSD、GluCV均较死亡组低,差异有统计学意义(P<0.05)。随着平均血糖区间的上升,死亡病例增加,差异有统计学意义(P<0.05);血糖变异度越高,病死率越高,差异有统计学意义(P<0.05)。随着GluAve的上升,死亡病例增加,差异有统计学意义(P<0.05);GluCV越高,病死率越高,差异有统计学意义(P<0.05)。结论创伤性重型、特重型颅脑损伤手术患者的应激性高血糖与不良预后具有相关性,是临床治疗策略的重要部分。临床上,我们不仅要采取必要的强化胰岛素治疗,将血糖水平控制在合理的区间,更要关注血糖的变异性,将血糖波动控制在合理水平。
Objective To study the effect of blood glucose on the prognosis of patients with severe or extremely severe craniocerebral injury.Methods 54 patients with severe or extremely severe craniocerebral injury in 990th Hospital of PLA from January 2015 to March 2020 were selected and divided into survival group(n=40)and death group(n=14)based on the 28d prognosis.The average blood glucose(GluAve),blood glucose standard deviation(GluSD),the blood glucose variation coefficient(GluCV)within 72 hours after admission,as well as the mortality rates were compared between the two groups.Results The GCS score,ApacheⅡscore were lower in death group than that of the survival group(P<0.05).GluAve,GluSD and GluCV were higher in death group than that of the survival group(P<0.05).With the increase of the average blood glucose interval,the number of deaths increased and the difference was statistically significant(P<0.05).The higher is the blood glucose variability,the higher is the mortality rate.The difference was statistically significant(P<0.05).With the rise of GluAve,the number of deaths also increased.The difference was statistically significant(P<0.05).The higher is the GluCV,the higher is the mortality rate and the difference was statistically significant(P<0.05).Conclusion The stress hyperglycemia and blood glucose in patients with severe or extremely severe craniocerebral injury has a correlation with poor prognosis and is an important part of clinical treatment strategies.Clinically,we must not only take the necessary intensive insulin therapy to control the blood glucose level within a reasonable range,but also pay attention to the variability of blood glucose and control the fluctuation of blood glucose to a reasonable level.
作者
李玲玲
陶有为
扈俊华
胡承啸
柴超
张晓娜
闫德祺
高玉松
LI Lingling;TAO Youwei;HU Junhua;HU Chengxiao;CHAI Chao;ZHANG Xiaona;YAN Deqi;GAO Yusong(The 990th Hospital,the Joint Logistics Support Force,PLA,Zhumadian 463000,China)
出处
《中国实用神经疾病杂志》
2020年第13期1136-1139,共4页
Chinese Journal of Practical Nervous Diseases
基金
后勤科研计划(编号:CJN14C064,CJN15J089)。
关键词
血糖水平
创伤性重型颅脑损伤
创伤性特重型颅脑损伤
手术
预后
Blood glucose level
Traumatic severe craniocerebral injury
Traumatic extremely severe craniocerebral injury
Surgery
Prognosis
作者简介
李玲玲,Email:304755326@qq.com;通信作者:高玉松,Email:vgys@163.com。
