Pentelényi T
National Institute of Traumatology, Department of Neurosurgery, Budapest, Hungary.
Acta Neurochir Suppl (Wien). 1992;55:21-4. doi: 10.1007/978-3-7091-9233-7_7.
Serial basal blood glucose, serum insulin, cortisol, growth hormone, glucagon and catecholamine examinations were performed in 81 brain-injured patients. 32 patients with severe injuries of other parts of the body (chest, abdomen, limbs or polytrauma), and 17 patients with non-traumatic acute brain lesions served as double control. In the brain-injured patients there is a close relation between changes of the state of consciousness and those of basal blood glucose levels: the deeper coma the higher and wider is the pathological glucose-level range. Four types of blood-glucose changes could be identified in the background of which different alterations of each hormone level were observed. Fatal outcome could be predicted in a non-diabetic patient in the first days when seeing: 1) Fasting hyperglycaemia above 14 mmol/l; 2) Fluctuating basal blood glucose levels between 5 and 22 mmol/l; 3) Deeply depressed and unchanged basal insulin level; 4) Extremely high cortisol level; 5) Decreased plasma epinephrine level. These changes in the carbohydrate metabolism seen after acute brain lesions are not identical to diabetes mellitus.
对81例脑损伤患者进行了系列基础血糖、血清胰岛素、皮质醇、生长激素、胰高血糖素和儿茶酚胺检测。32例身体其他部位（胸部、腹部、四肢或多发伤）严重损伤患者以及17例非创伤性急性脑病变患者作为双重对照。在脑损伤患者中，意识状态变化与基础血糖水平变化密切相关：昏迷越深，病理性血糖水平范围越高且越宽。可以识别出四种血糖变化类型，在此背景下观察到每种激素水平的不同改变。在非糖尿病患者中，若出现以下情况，可在最初几天预测到致命结局：1）空腹血糖高于14 mmol/l；2）基础血糖水平在5至22 mmol/l之间波动；3）基础胰岛素水平极度降低且无变化；4）皮质醇水平极高；5）血浆肾上腺素水平降低。急性脑损伤后出现的这些碳水化合物代谢变化与糖尿病并不相同。
