Khajavikhan Javaher, Vasigh Aminolah, Kokhazade Taleb, Khani Ali
Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran .
Student, Department of Nursing, Nursing & Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran .
J Clin Diagn Res. 2016 Apr;10(4):PC11-3. doi: 10.7860/JCDR/2016/17208.7686. Epub 2016 Apr 1.
Head Trauma (HT) is a major cause of death, disability and important public health problem. HT is also the main cause of hyperglycaemia that can increase mortality.
The aim of this study was to assess the correlation between hyperglycaemia with neurological outcomes following severe Traumatic Brain Injury (TBI).
This is a descriptive and correlation study that was carried out at the Imam Khomeini Hospital affiliated with Ilam University of Medical Sciences, Ilam, IR, during March 2014-March 2015 on patients with severe TBI. Data were collected from the patient records on mortality, Intensive Care Unit (ICU) length of stay, hospital length of stay, admission GCS score, Injury Severity Score (ISS), mechanical ventilation, Ventilation Associated Pneumonia (VAP) and Acute Respiratory Distress Syndrome (ARDS). Random Blood Sugar (RBS) level on admission was recorded. Patients with diabetes mellitus (to minimize the overlap between acute stress hyperglycaemia and diabetic hyperglycaemia) were excluded.
About 34(40%) of patients were admitted with hyperglycaemia (RBS ≥ 200 mg/dl) over the study period. The mortality rate, length of ICU stay, hospital stay, ISS and VAP & ARDS in patients with RBS levels ≥ 200 mg was significantly higher than patients with RBS levels below ≤ 200mg (p<0.05, p<0.001). A significant correlation was found between RBS with GCS arrival, length of ICU stay, length of hospital stay, ISS, mechanical ventilation and VAP & ARDS (p<0.05, p< 0.001). RBS is a predicate factor for ISS (p <0.05, OR : 1.36), GCS (p <0.001, OR : 1.69), mechanical ventilation (p< 0.05, OR : 1.27), VAP & ARDS (p <0.001, OR : 1.68), length of ICU stay (p <0.001, OR : 1.87) and length of hospital stay (p <0.05, OR : 1.24).
Hyperglycaemia after severe TBI (RBS ≥ 200) is associated with poor outcome. It can be a predictive factor for mortality rate, ICU stay, GCS arrival, VAP & RDS, hospital stay and ISS. Management of hyperglycaemia with insulin protocol in cases with value >200mg/dl, is critical in improving the outcome of patients with TBI.
头部创伤（HT）是导致死亡、残疾的主要原因，也是一个重要的公共卫生问题。HT 还是可增加死亡率的高血糖症的主要原因。
本研究的目的是评估严重创伤性脑损伤（TBI）后高血糖症与神经学预后之间的相关性。
这是一项描述性和相关性研究，于 2014 年 3 月至 2015 年 3 月在伊朗伊拉姆医科大学附属伊玛目霍梅尼医院对重度 TBI 患者进行。从患者记录中收集有关死亡率、重症监护病房（ICU）住院时间、住院时间、入院格拉斯哥昏迷评分（GCS）、损伤严重程度评分（ISS）、机械通气、呼吸机相关性肺炎（VAP）和急性呼吸窘迫综合征（ARDS）的数据。记录入院时的随机血糖（RBS）水平。排除患有糖尿病的患者（以尽量减少急性应激性高血糖症和糖尿病性高血糖症之间的重叠）。
在研究期间，约 34 名（40%）患者入院时患有高血糖症（RBS≥200mg/dl）。RBS 水平≥200mg 的患者的死亡率、ICU 住院时间、住院时间、ISS 以及 VAP 和 ARDS 显著高于 RBS 水平≤200mg 的患者（p<0.05，p<0.001）。发现 RBS 与 GCS 入院评分、ICU 住院时间、住院时间、ISS、机械通气以及 VAP 和 ARDS 之间存在显著相关性（p<0.05，p<0.001）。RBS 是 ISS（p<0.05，OR：1.36）、GCS（p<0.001，OR：1.69）、机械通气（p<0.05，OR：1.27）、VAP 和 ARDS（p<0.001，OR：1.68）、ICU 住院时间（p<0.001，OR：1.87）和住院时间（p<0.05，OR：1.24）的预测因素。
重度 TBI 后高血糖症（RBS≥200）与不良预后相关。它可能是死亡率、ICU 住院时间、GCS 入院评分、VAP 和 RDS、住院时间以及 ISS 的预测因素。对于 RBS 值>200mg/dl 的病例，采用胰岛素方案管理高血糖症对于改善 TBI 患者的预后至关重要。
