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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
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张宁,韩双剑,于凡,赵文静.应激性高血糖对重型颅脑损伤术后患者预后的影响[J].中华老年多器官疾病杂志,2020,19(7):525~529
应激性高血糖对重型颅脑损伤术后患者预后的影响
Effect of stress-induced hyperglycemia on prognosis in patients with severe brain injury
投稿时间:2019-08-30  
DOI:10.11915/j.issn.1671-5403.2020.07.124
中文关键词:  重型颅脑损伤术后;应激性高血糖;糖尿病;预后;危险因素
英文关键词:severe brain injury; stress-induced hyperglycemia; diabetes mellitus; prognosis; risk factors This work was supported by the Level D Project of “Six-Major Talents Summit” of Jiangsu Province
基金项目:江苏省“六大人才高峰”D 类资助项目(2009059);徐州市科技厅课题(KC16SY150)
作者单位E-mail
张宁 徐州医科大学附属医院重症医学科,江苏 徐州 221000;徐州医科大学麻醉学院麻醉系,江苏 徐州 221004 zhaowj886@sina.comeffect 
韩双剑 徐州医科大学麻醉学院麻醉系,江苏 徐州 221004 zhaowj886@sina.comeffect 
于凡 徐州医科大学麻醉学院麻醉系,江苏 徐州 221004 zhaowj886@sina.comeffect 
赵文静 徐州医科大学附属医院重症医学科,江苏 徐州 221000 zhaowj886@sina.comeffect 
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中文摘要:
      目的 探讨重型颅脑损伤术后合并应激性高血糖对患者预后的影响。方法 采用回顾性研究方法,选择2016年1月至2018年12月就诊于徐州医科大学附属医院、经影像学确诊、根据格拉斯哥昏迷(GCS)评分评为重型颅脑损伤(GCS评分为3~8分)、并行外科开颅血肿清除术治疗、术后入重症医学科进一步治疗的患者。将患者分为正常血糖组、应激性高血糖组和糖尿病组,比较3组患者的28d病死率、ICU住院时间及并发症。应用SPSS 16.0软件进行统计学分析。数据分别用均数±标准差(±s)、中位数和四分位数间距[M(Q1, Q3)]或例数(百分率)表示;依据数据类型分别采用单因素方差分析、SNK-q检验、Kruskal-Waills秩和检验、χ2检验或Fisher确切概率法对数据进行比较。生存资料分析采用 Kaplan-Meier方法绘制生存曲线,组间生存率的比较采用 Log-rank检验。采用Cox回归模型分析影响预后的危险因素。结果 共收集165例患者,每组各55例。Kaplan-Meier生存分析显示,应激性高血糖组28d累积存活率较正常血糖组和糖尿病组明显下降。应激性高血糖组28d病死率43.27%(26/55)>糖尿病组23.64%(13/55)>正常血糖组18.18%(10/55),两两比较显示,应激性高血糖组死亡率较正常血糖组及糖尿病组均明显升高(均P<0.05),正常血糖组与糖尿病组相比,差异无统计学意义(P>0.05)。3组患者4周内的并发症及ICU住院时间比较显示:应激性高血糖组患者4周内肺部感染发生率显著高于正常血糖组[58.18%(32/55)和34.55%(19/55),P<0.05],而较糖尿病组[49.10%(27/55)]有所升高,但差异无统计学意义(P>0.05);3组之间颅内感染、继发脑梗死、下肢深静脉血栓形成、急性肾功能衰竭等并发症发生情况及ICU住院时间均无统计学差异(P>0.05)。多变量Cox 比例风险回归模型分析显示,应激性高血糖(HR=1.16,95%CI 1.07~1.26)是影响预后的危险因素之一。结论 合并应激性高血糖的重型颅脑损伤术后患者28d病死率显著高于正常血糖及糖尿病史患者,提示应激性高血糖是影响预后的危险因素。
英文摘要:
      Objective To investigate the effect of stress-induced hyperglycemia on the prognosis of the patients after operation for severe craniocerebral injury. Methods A retrospective study was conducted on the patients with severe craniocerebral injury confirmed by radiological imaging and Glasgow Coma score (GCS score, 3 to 8 points), who were admitted to our hospital from January 2016 to December 2018. After surgical treatment, all the patients were transferred to the intensive care unit (ICU) for further treatment, and were divided into normoglycemia group, stressinduced hyperglycemia group and diabetes mellitus group. The 28-day mortality, length of ICU stay, and complications were compared among the three groups. SPSS statistics 16.0 was used to perform the statistical analysis. Data were expressed as mean±standard deviation (±s), median and interquartile range [M(Q1, Q3)], or number of cases (percentage). According to the data type, one-way analysis of variance, SNK-q test, Kruskal-Waills rank sum test, Chi-square test or Fisher exact probability test were employed for comparison. Survival data were analyzed using Kaplan-Meier method to draw survival curves, and intergroup comparison of survival rates was performed using Log-rank test. Cox regression model was applied to analyze the risk factors affecting prognosis. Results A total of 165 patients were enrolled, with 55 in each group. Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate was significantly lower in the stress-induced hyperglycemia group than thenormoglycemia group and the diabetes mellitus group. The 28-day mortality rate was obviously higher in the stress-induced hyperglycemia group [43.27%, (26/55)] followed by the diabetes mellitus group [23.64%, (13/55)] and the normoglycemia group [18.18%, (10/55)] sequentially. The mortality of the stress-induced hyperglycemia group was significantly higher than those of the other 2 groups (both P<0.05). But no such difference was seen between the normoglycemia group and the diabetes mellitus group (P>0.05). The incidence of pulmonary infection within 4 weeks were notably higher in the stress-induced hyperglycemia group than the normoglycemia group [58.18%(32/55) vs 34.55%(19/55), P<0.05], and was higher than the diabetes mellitus group [49.10%(27/55)], but the difference was not statistically significant (P>0.05). There were no remarkable differences in the incidences of complications, such as intracranial infection, secondary cerebral infarction, deep venous thrombosis of the lower extremity, acute renal failure and ICU stay length among the 3 groups (P>0.05). Multivariate Cox proportional hazard regression analysis showed that stress-induced hyperglycemia was one of the risk factors affecting prognosis (HR=1.16,95%CI:1.07-1.26). Conclusion The 28-day mortality rate is significantly higher in the patients with severe craniocerebral injury complicated with stress-induced hyperglycemia than those with normoglycemia and diabetes history, suggesting that stress-induced hyperglycemia is a risk factor for prognosis.
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