Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
Crit Care. 2018 Jan 25;22(1):16. doi: 10.1186/s13054-017-1933-5.
Optimal glycaemic targets for patients with severe traumatic brain injury remain unclear. The primary objective of this microdialysis study was to compare cerebral metabolism with strict versus conventional glycaemic control.
We performed a prospective single-centre randomised controlled within-subject crossover study of 20 adult patients admitted to an academic neurointensive care unit with severe traumatic brain injury. Patients underwent randomised, consecutive 24-h periods of strict (4-7 mmol/L; 72-126 mg/dl) and conventional (<10 mmol/L; 180 mg/dl) glycaemic control with microdialysis measurements performed hourly. The first 12 h of each study period was designated as a 'washout' period, with the subsequent 12 h being the period of interest.
Cerebral glucose was lower during strict glycaemia than with conventional control (mean 1.05 [95% CI 0.58-1.51] mmol/L versus 1.28 [0.81-1.74] mmol/L; P = 0.03), as was lactate (3.07 [2.44-3.70] versus 3.56 [2.81-4.30]; P < 0.001). There were no significant differences in pyruvate or the lactate/pyruvate ratio between treatment phases. Strict glycaemia increased the frequency of low cerebral glucose (< 0.8 mmol/L; OR 1.91 [95% CI 1.01-3.65]; P < 0.05); however, there were no differences in the frequency of critically low glucose (< 0.2 mmol/L) or critically elevated lactate/pyruvate ratio between phases.
Compared with conventional glycaemic targets, strict blood glucose control was associated with lower mean levels of cerebral glucose and an increased frequency of abnormally low glucose levels. These data support conventional glycaemic targets following traumatic brain injury.
ISRCTN, ISRCTN19146279 . Retrospectively registered on 2 May 2014.
严重创伤性脑损伤患者的最佳血糖目标仍不清楚。这项微透析研究的主要目的是比较严格与常规血糖控制对脑代谢的影响。
我们进行了一项前瞻性、单中心、随机、自身交叉对照研究，纳入 20 名因严重创伤性脑损伤而入住学术性神经重症监护病房的成年患者。患者接受随机、连续 24 小时的严格（4-7mmol/L；72-126mg/dl）和常规（<10mmol/L；180mg/dl）血糖控制，每小时进行微透析测量。每个研究期间的前 12 小时为“洗脱”期，随后的 12 小时为观察期。
与常规血糖控制相比，严格血糖控制时脑葡萄糖水平更低（平均 1.05[95%CI 0.58-1.51]mmol/L 比 1.28[0.81-1.74]mmol/L；P=0.03），乳酸也更低（3.07[2.44-3.70]mmol/L 比 3.56[2.81-4.30]mmol/L；P<0.001）。治疗阶段之间丙酮酸或乳酸/丙酮酸比值无显著差异。严格血糖控制增加了低血糖（<0.8mmol/L；OR 1.91[95%CI 1.01-3.65]；P<0.05）的发生频率；然而，两个阶段之间低血糖（<0.2mmol/L）或乳酸/丙酮酸比值显著升高的发生率无差异。
与常规血糖目标相比，严格血糖控制与脑葡萄糖水平的平均水平降低以及异常低血糖水平的发生频率增加相关。这些数据支持创伤性脑损伤后采用常规血糖目标。
ISRCTN，ISRCTN19146279。于 2014 年 5 月 2 日回顾性注册。
