Gore D C, Chinkes D, Heggers J, Herndon D N, Wolf S E, Desai M
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
J Trauma. 2001 Sep;51(3):540-4. doi: 10.1097/00005373-200109000-00021.
Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury.
Survey of the medical records from January 1996 to July 1999 identified 58 pediatric patients with burns > or = 60% body surface. Patients were categorized as having poor glucose control (n = 33) if > or = 40% of all plasma glucose determinations were > or = 7.8 mmol/L (140 mg/dL) and compared with patients deemed to have adequate glucose control (n = 25) in whom > or = 40% of all glucose values were > or = 7.8 mmol/L.
Despite similar age, burn size, caloric intake, and frequency of wound infection, patients categorized with poor glucose control had a significantly greater incidence of positive blood cultures (positive blood cultures/length of stay days, 0.42 +/- 0.04 for hyperglycemia patients vs. 0.30 +/- 0.03 for normoglycemia patients; mean +/- SEM, p > or = 0.05). This finding was especially prominent for blood cultures positive for yeast. Hyperglycemia patients had significantly less percentage of skin graft take than did the normoglycemic patients (percent take/operative procedure, 64 +/- 9 for hyperglycemia patients vs. 88 +/- 5 for normoglycemia patients; p < 0.05). Nine patients (27%) with persistent hyperglycemia died compared with only one death (4%) in patients with adequate glucose control (p > or = 0.05).
This association between poor glucose control, bacteremia/fungemia, reduced skin graft take, and subsequent mortality in severely burned children may be related to a hyperglycemia-induced detriment in antimicrobial defense. Although this report fails to establish cause and effect, these findings suggest that aggressive maneuvers to normalize plasma glucose in critically injured patients may be warranted.
高血糖通常与高代谢应激反应相关。然而，持续性高血糖可能对伤口愈合和免疫力产生不利影响。本研究的目的是评估严重烧伤后高血糖与临床结局之间的关系。
对1996年1月至1999年7月的病历进行调查，确定了58例烧伤面积≥60%体表面积的儿科患者。如果所有血浆葡萄糖测定值中≥40%≥7.8 mmol/L（140 mg/dL），则将患者归类为血糖控制不佳（n = 33），并与所有血糖值中≥40%≥7.8 mmol/L的血糖控制良好的患者（n = 25）进行比较。
尽管年龄、烧伤面积、热量摄入和伤口感染频率相似，但血糖控制不佳的患者血培养阳性率显著更高（血培养阳性率/住院天数，高血糖患者为0.42±0.04，正常血糖患者为0.30±0.03；平均值±标准误，p≥0.05）。这一发现对于酵母血培养阳性尤为突出。高血糖患者的植皮成活率明显低于正常血糖患者（植皮成活率/手术例数，高血糖患者为64±9，正常血糖患者为88±5；p < 0.05）。9例（27%）持续性高血糖患者死亡，而血糖控制良好的患者仅有1例死亡（4%）（p≥0.05）。
严重烧伤儿童血糖控制不佳、菌血症/真菌血症、植皮成活率降低及随后的死亡率之间的这种关联可能与高血糖诱导的抗菌防御损害有关。尽管本报告未能确立因果关系，但这些发现表明，对重症患者采取积极措施使血糖正常化可能是必要的。
