重型颅脑损伤后血糖变化与预后关系的分析(1)
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【摘要】目的探讨重型颅脑损伤后血糖变化与预后的关系。方法对116例重型颅脑损伤患者(GCS≤8分),以入院时GCS评分判定病情分成3~4分组(34例),5~6分组(38例),7~8分组(44例),入院后12 h内取静脉血测定空腹血糖值进行回顾性分析,观察血糖浓度与GCS评分的关系。并对血糖变化与预后(良好、差、死亡)进行分析。结果重型颅脑损伤患者血糖明显增高,GCS评分三组间血糖值有显著性差异(P<0.01),入院时GCS评分越低,血糖越高,预后越差。结论高血糖可严重影响颅脑损伤的预后,及时有效地控制血糖,能改善患者的神经功能及预后,提高生存质量。
【关键词】
颅脑损伤;血糖;预后
Analysis of the relationship between blood glucose by gravis type craniocerebral injury and prognosis
DAI Xiuqin,ZHAO Yuxia.Department of Neurosurgery,The First People’s Hospital of Shangqiu in Henan province,Shangqiu 476100,China
【Abstract】ObjectiveTo explore the effect of blood glucose(BG)fluctuation by severe type craniocerebral injury on the prognosis.MethodsRetrospective reviews were done to 116 patients of gravis type craniocerebral injury whose GCS Score ≤8.According to the GCS Score at admission,116 patients were divided into three groups,34 cases for GCS Score34 scores,38 casesfor GCS Score56 scores,44 casesfor GCS Score78 scores,median cubical vein blood were taken to check fasting plasma glucose within 12 hours at admission,to observe the relationship between the blood glucose concentration and GCS Score.The blood glucose fluctuation and prognosis were analyzed by the discharge condition,including improvement,poor treatment and death.ResultsThe BG value was higher than the normal reference value after the patients suffered from the craniocerebral injury.The blood glucose values were significantly different in the three groups ﹙P<0.01﹚.The lower the GCS Score,the higher the BG value,the worse the prognosis.ConclusionHyperglycemia can seriously affect the prognosis of patients with craniocerebral injury,if the hyperglycemia was controlled promptly and effectively,the nervous function and prognosis will be improved,and the quality of lifebe enhanced.
【Key words】
Craniocerebral injury;Blood glucose;Prognosis
重型颅脑损伤后往往由于应激而致血糖增高,而高血糖会加重脑的损伤,并影响中枢神经功能的恢复。经国内外大量的实验及临床研究发现,伤势越重,血糖升高越明显,预后也越差[1]。我科2003年6月至2008年6月共收治重型颅脑损伤(GCS≤8)116例,我们对其入院后12 h内测定的空腹血糖进行回顾性分析,探讨高血糖与预后的关系,并对其临床意义进行分析,现报告如下。
1资料与方法
1.1临床资料116例中男81例,女35例,年龄14~71岁,平均38.6岁,损伤原因:车祸伤80例,打击伤22例,坠落伤16例。损伤类型;脑挫裂伤38例,颅内血肿40例,脑挫裂伤伴颅内血肿38例。其中GCS3~4分34例,GCS5~6分38例,GCS7~8分44例。
1.2血糖测定患者入院后即刻采静脉血2 ml送检测定血糖(血生化全套),所有血样取于伤后12 h内,采血前8 h内患者均无外源性葡萄糖滴注史 ......
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