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目的了解高血糖与颅脑损伤严重程度之间的关系以及控制血糖对颅脑损伤预后的影响。方法我们前瞻性地研究了146例中重型颅脑损伤患者(格拉斯哥昏迷评分GCS3~12分)的血糖,并将血糖高于11.1mmol/L的患者随机分为两组,一组接受强化胰岛素治疗,将血糖控制在6.11mmol/L以下,另一组不接受胰岛治疗,以明确血糖水平同损伤严重程度之间的关系以及控制血糖对预后的影响。结果重型颅脑损伤患者的血糖水平明显高于中型颅脑损伤患者,并且颅内压水平同血糖水平显著相关。同血糖水平高于11.1mmol/L的患者相比,血糖控制在6.11mmol/L以下的患者预后明显改善。结论早期高血糖是颅脑损伤后应激反应的一个组成部分,是预测损伤严重度的一个重要指标,控制血糖可改善颅脑损伤患者的预后。
Objective To understand the relationship between hyperglycemia and the severity of craniocerebral injury and to control the effect of blood glucose on the prognosis of craniocerebral injury. Methods We prospectively studied the blood glucose of 146 patients with moderate-to-severe head injury (Glasgow Coma Scale GCS 3 to 12) and randomized patients with elevated glucose above 11.1 mmol / L into two groups, one receiving intensive insulin therapy , The blood glucose control in 6.11mmol / L or less, and the other group does not accept islet therapy to clarify the relationship between blood glucose levels and the severity of the injury and control of blood glucose on the prognosis. Results The blood glucose level of patients with severe craniocerebral injury was significantly higher than that of patients with moderate craniocerebral injury, and the level of intracranial pressure was significantly correlated with blood glucose level. Patients with glycemic control below 6.11 mmol / L had significantly better outcomes than those with blood glucose levels above 11.1 mmol / L. Conclusion Early hyperglycemia is a component of stress response after craniocerebral injury and is an important index to predict the severity of injury. Controlling blood sugar can improve the prognosis of patients with craniocerebral injury.