Parish R A, Webb K S
Department of Pediatrics, University of Washington School of Medicine, Seattle.
J Trauma. 1988 Apr;28(4):517-9. doi: 10.1097/00005373-198804000-00017.
Hyperglycemia among adult trauma patients with head injuries is a recognized phenomenon which has been shown to be associated with a poor prognosis when it takes the form of nonketotic hyperosmolar hyperglycemia. It is not known to what extent a similar phenomenon occurs in pediatric patients, although it is known that a child's physiologic response to injury, particularly to neurologic injury, is often different than an adult's. This study was undertaken to characterize the hyperglycemic response of children with closed head injury compared to children with a non-head injury, and to measure the extent to which the presence of hyperglycemia is associated with a poor outcome among children with severe head injury. Records for all children ages 2 to 12 years admitted to a major regional trauma center with closed head injury over a 6-year period were compared to the records of a control group of children hospitalized for a non-head injury. The hyperglycemic response was more common among those with head trauma, occurring in 40% compared to 5% of the controls (p less than 0.001); however, the level of hyperglycemia could not be associated with any indicator of outcome. The entity known as nonketotic hyperosmolar hyperglycemia did not occur in any of these patients. Apparently, the hyperglycemia associated with closed head injury in children is transient, does not need to be treated with insulin therapy, and in contrast to what has been demonstrated in adult trauma patients, does not predict patient outcome.
成年颅脑损伤患者出现高血糖是一种公认的现象，当表现为非酮症高渗性高血糖时，已被证明与预后不良有关。尽管已知儿童对损伤，尤其是对神经损伤的生理反应通常与成人不同，但尚不清楚类似现象在儿科患者中出现的程度。本研究旨在描述闭合性颅脑损伤儿童与非颅脑损伤儿童的高血糖反应特征，并衡量高血糖的存在与重度颅脑损伤儿童不良预后的相关程度。将一家主要地区创伤中心在6年期间收治的所有2至12岁闭合性颅脑损伤儿童的记录与因非颅脑损伤住院的对照组儿童的记录进行比较。高血糖反应在颅脑外伤患者中更为常见，发生率为40%，而对照组为5%（p小于0.001）；然而，高血糖水平与任何预后指标均无关联。这些患者中均未出现非酮症高渗性高血糖。显然，儿童闭合性颅脑损伤相关的高血糖是短暂的，无需胰岛素治疗，而且与成年创伤患者的情况不同，它不能预测患者的预后。
