Salim Ali, Hadjizacharia Pantelis, Dubose Joseph, Brown Carlos, Inaba Kenji, Chan Linda S, Margulies Daniel
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Am Surg. 2009 Jan;75(1):25-9.
In patients with severe traumatic brain injury (TBI), admission hyperglycemia is associated with poor outcome. The effect of persistent hyperglycemia (PH) on outcome in severe TBI, however, remains unknown. We performed a retrospective review of all blunt trauma patients with severe TBI (head Abbreviated Injury Score > or = 3) admitted to the intensive care unit at a Level I trauma center from January 1998 through December 2005. Admission and daily intensive care unit blood glucose levels up to the end of the first week were measured. PH was defined as an average daily blood glucose > or = 150 mg/dL on all days for the first week of the hospital stay. TBI patients with and without PH were compared with respect to baseline demographics, injury characteristics, and outcomes. Independent risk factors for mortality were identified using logistic regression analysis. One hundred and five (12.6%) out of 834 severe TBI patients had PH. Patients with PH were older, more severely injured, and had worse head injury compared with patients without PH. After adjusting for significant risk factors, PH was identified as an independent risk factor for mortality (odds ratio (OR): 4.91 [95% confidence interval (CI), 2.88-8.56, P < 0.0001]). PH is associated with significantly higher mortality rates in severe TBI patients.
在重度创伤性脑损伤（TBI）患者中，入院时高血糖与预后不良相关。然而，持续性高血糖（PH）对重度TBI患者预后的影响仍不清楚。我们对1998年1月至2005年12月期间在一级创伤中心重症监护病房收治的所有重度TBI钝性创伤患者（头部简明损伤评分≥3）进行了回顾性研究。测量入院时及直至第一周结束时重症监护病房每日血糖水平。PH定义为住院第一周所有日子的平均每日血糖≥150mg/dL。比较了有和没有PH的TBI患者的基线人口统计学、损伤特征和预后。使用逻辑回归分析确定死亡的独立危险因素。834例重度TBI患者中有105例（12.6%）发生PH。与没有PH的患者相比，发生PH的患者年龄更大、损伤更严重、头部损伤更差。在对显著危险因素进行校正后，PH被确定为死亡的独立危险因素（比值比（OR）：4.91[95%置信区间（CI），2.88 - 8.56，P < 0.0001]）。PH与重度TBI患者的死亡率显著升高相关。
