Department of Anesthesiology and Pain Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359724, Seattle, WA 98104, USA.
Anesth Analg. 2011 Aug;113(2):336-42. doi: 10.1213/ANE.0b013e31821d3dde. Epub 2011 May 19.
Hyperglycemia after traumatic brain injury (TBI) is associated with poor outcome, but previous studies have not addressed intraoperative hyperglycemia in adult TBI. In this study, we examined glucose value variability and risk factors for hyperglycemia during craniotomy in adults with TBI.
A retrospective cohort study of patients ≥18 years who underwent urgent or emergent craniotomy for TBI at Harborview Medical Center (level 1 adult and pediatric trauma center) between October 2007 and May 2010 was performed. Preoperative (within 24 hours of anesthesia start) and intraoperative (during anesthesia) glucose values for each patient were retrieved. The prevalence of intraoperative hyperglycemia (glucose ≥200 mg/dL), hypoglycemia (glucose <60 mg/dL), and glycemic trends was determined. Generalized Estimating Equations was used to determine the independent predictors of intraoperative hyperglycemia. Data are presented as adjusted odds ratio (AOR) (95% confidence interval [CI]), and P < 0.05 reflects significance.
Intraoperative hyperglycemia was common (26 [15%]) and intraoperative hypoglycemia was not observed. Independent risk factors of intraoperative hyperglycemia were age ≥65 years (AOR 3.9 [95% CI: 1.4-10.3]; P = 0.007), Glasgow Coma Scale score <9 (AOR 4.9 [95% CI: 1.6-15.1]; P = 0.006), preoperative hyperglycemia (AOR 4.4 [95% CI: 1.7-11.6]; P = 0.003), and subdural hematoma (AOR 5.6 [95% CI: 1.4-22.2]; P = 0.02). Mean intraoperative glucose was highest in severe TBI patients (P = 0.02). There was both between-patient (79.5% variance; P < 0.001) and within-patient (20.5% variance; P < 0.001) intraoperative glucose value variability. Patients with intraoperative hyperglycemia had higher in-hospital mortality (8 [31%] vs 20 [13%]; P < 0.02).
Intraoperative hyperglycemia was common in adults undergoing urgent/emergent craniotomy for TBI and was predicted by severe TBI, the presence of subdural hematoma, preoperative hyperglycemia, and age ≥65 years. However, there was significant variability in intraoperative glucose values.
颅脑创伤（TBI）后高血糖与不良预后相关，但既往研究并未探讨成人 TBI 术中高血糖。本研究旨在探讨成人 TBI 患者开颅术中血糖值变异性及其与高血糖的关系。
回顾性分析 2007 年 10 月至 2010 年 5 月在 Harborview 医学中心（1 级成人和儿科创伤中心）因 TBI 行急诊或紧急开颅术的≥18 岁患者。收集每位患者术前（麻醉开始后 24 小时内）和术中（麻醉期间）的血糖值。确定术中高血糖（血糖≥200mg/dL）、低血糖（血糖＜60mg/dL）和血糖趋势的发生率。采用广义估计方程确定术中高血糖的独立预测因素。数据表示为调整后比值比（AOR）（95%置信区间[CI]），P＜0.05 为差异有统计学意义。
术中高血糖较为常见（26 例[15%]），未发生术中低血糖。术中高血糖的独立危险因素为年龄≥65 岁（AOR 3.9[95%CI：1.4-10.3]；P=0.007）、格拉斯哥昏迷评分＜9 分（AOR 4.9[95%CI：1.6-15.1]；P=0.006）、术前高血糖（AOR 4.4[95%CI：1.7-11.6]；P=0.003）和硬膜下血肿（AOR 5.6[95%CI：1.4-22.2]；P=0.02）。重度 TBI 患者术中平均血糖最高（P=0.02）。患者间（79.5%的变异性；P＜0.001）和患者内（20.5%的变异性；P＜0.001）血糖值均存在较大差异。术中高血糖患者院内死亡率较高（8 例[31%]vs 20 例[13%]；P＜0.02）。
成人 TBI 患者行急诊/紧急开颅术时术中高血糖较为常见，严重 TBI、硬膜下血肿、术前高血糖和年龄≥65 岁是其发生的预测因素。但术中血糖值存在较大变异性。
