目的：分析空腹血糖水平变化在脑损伤患者中的临床意义及其与脑损伤程度的关系，为判断患者的预后、指导临床治疗提供理论依据。方法选取本院2009年6月至2011年6月收治的213例脑损伤患者，按照其脑损伤程度分为轻、中、重度脑损伤组，比较三组患者空腹血糖水平差异，同时分析患者预后与空腹血糖水平的相关性。结果 T1～T3时段重度脑损伤组患者空腹血糖水平显著高于中、轻度脑损伤组，中度脑损伤组患者空腹血糖水平亦显著高于轻度脑损伤组（P＜0.05）；轻度脑损伤组患者T2时即见空腹血糖水平降低，中、重度脑损伤组患者T2时空腹血糖水平上升，T3时空腹血糖水平降低。三组患者均获得有效随访，平均随访时间为（11.7±0.5）个月。随访中可见，预后良好65例，预后较差103例，死亡45例。死亡组患者T1～T3时段空腹血糖水平均显著高于预后较差组及预后良好组，预后较差组患者空腹血糖水平亦显著高于预后良好组（P＜0.05）；预后良好组患者T2时空腹血糖水平降至正常值，预后较差及死亡患者T3时空腹血糖水平出现降低趋势，但未降至正常水平。以空腹血糖水平为自变量，格拉斯哥昏迷评分（GCS）为因变量，Spearman's相关分析提示y＝-0.74x＋17.305，空腹血糖水平与GCS评分呈负相关，即血糖增高程度与脑损伤程度呈高度正相关（r＝0.74，P＜0.01）。结论脑损伤患者受伤后出现明显的空腹血糖升高反应，而空腹血糖升高程度与患者的脑损伤程度呈正相关，在今后的治疗中，应密切监测脑损伤患者的空腹血糖水平，及时调整治疗策略，防止神经系统后遗症的发生，保证患者的生活及生存质量。%Objective To analyze the clinical signiifcance of fasting blood glucose level changes in patients with brain trauma and its correlations with the extent of brain trauma, provide theoretical basis for determining prognosis of patients and guiding clinical treatment. Method 213 cases of patients with brain trauma treated in our hospital from June 2009 to June 2011 were divided into mild, moderate, and severe group according to the extent of brain trauma. The difference of fasting blood glucose levels in the three groups were compared. The correlations between prognosis of patients and fasting blood glucose levels were investigated. Result In stage T1 ~ T3, the fasting blood glucose levels of severe brain trauma group were signiifcantly higher than that in moderate and mild brain trauma group. In addition, fasting blood glucose levels of moderate brain trauma group were signiifcantly higher than that in mild brain trauma group (P < 0.05). In stage T2, fasting blood glucose levels in patients with mild brain trauma decreased, while glucose levels in moderate and severe group increased. In stage T3, fasting blood glucose levels decreased. All patients of the three groups were effectively followed up, with the average time of (11.7±0.5) months. In the follow-up, there were 65 cases of good prognosis, 103 cases of poor prognosis and 45 cases of deaths. Fasting blood glucose levels of death group were higher than that in poor and good prognosis group in stage T1~T3. Fasting blood glucose levels of poor prognosis group were higher than that in good prognosis group (P<0.05). In stage T2, fasting blood glucose levels reduced to normal level. In stage T3, fasting blood glucose levels in poor prognosis and death group decreased, but not to normal level. Fasting blood glucose level was set as independent variable, and GCS as dependent variable. Spearman’s analysis indicated y=0.74x+17.305. Fasting blood glucose level was negatively correlated with GCS scores, scilicet the increasing extent of blood glucose was highly positively correlated with the extent of brain trauma (r = 0.74, P < 0.01). Conclusion Significant blood glucose increasing would occur after the patients with brain trauma is injured. The increasing extent of blood glucose is positively correlated with the extent of brain trauma. In the future treatment of brain trauma, fast blood glucose level should be closely monitored and treatment strategies should be adjusted in time in order to prevent the genesis of neurological sequelae and to guarantee the quality of life and survival.
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