Donnelly Joseph, Czosnyka Marek, Sudhan Nazneen, Varsos Georgios V, Nasr Nathalie, Jalloh Ibrahim, Liu Xiuyun, Dias Celeste, Sekhon Mypinder S, Carpenter Keri L H, Menon David K, Hutchinson Peter J, Smielewski Peter
Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK,
Neurocrit Care. 2015 Feb;22(1):20-5. doi: 10.1007/s12028-014-0042-4.
Increased blood glucose and impaired pressure reactivity (PRx) after traumatic brain injury (TBI) are both known to correlate with unfavorable patient outcome. However, the relationship between these two variables is unknown.
To test the hypothesis that increased blood glucose leads to increased PRx, we retrospectively analyzed data from 86 traumatic brain injured patients admitted to the Neurocritical Care Unit. Data analyzed included arterial glucose concentration, intracranial pressure (ICP), cerebral perfusion pressure (CPP) and end-tidal CO2. PRx was calculated as the moving correlation coefficient between averaged (10 seconds) arterial blood pressure and ICP. One arterial glucose concentration and one time-aligned PRx value were obtained for each patient, during each day until the fifth day after ictus.
Mean arterial glucose concentrations during the first 5 days since ictus were positively correlated with mean PRx (Pearson correlation coefficient = 0.25, p = 0.02). The correlation was strongest on the first day after injury (Pearson correlation coefficient = 0.47, p = 0.008).
Our preliminary findings indicate that increased blood glucose may impair cerebrovascular reactivity, potentially contributing to a mechanistic link between increased blood glucose and poorer outcome after TBI.
创伤性脑损伤（TBI）后血糖升高和压力反应性（PRx）受损均与患者不良预后相关。然而，这两个变量之间的关系尚不清楚。
为了验证血糖升高导致PRx升高的假设，我们回顾性分析了86例入住神经重症监护病房的创伤性脑损伤患者的数据。分析的数据包括动脉血糖浓度、颅内压（ICP）、脑灌注压（CPP）和呼气末二氧化碳。PRx计算为平均（10秒）动脉血压与ICP之间的移动相关系数。在发病后直至第五天的每一天，为每位患者获取一个动脉血糖浓度和一个时间对齐的PRx值。
发病后前5天的平均动脉血糖浓度与平均PRx呈正相关（Pearson相关系数 = 0.25，p = 0.02）。这种相关性在受伤后第一天最强（Pearson相关系数 = 0.47，p = 0.008）。
我们的初步研究结果表明，血糖升高可能损害脑血管反应性，这可能是血糖升高与TBI后较差预后之间机制联系的原因。
