入院高血糖对中重型创伤性脑损伤患儿死亡的影响

Effect of early hyperglycemia on the mortality in pediatric patients with moderate to severe traumatic brain injury

摘要:

目的：探讨入院高血糖对中重型创伤性脑损伤（traumatic brain injury，TBI）患儿死亡的影响。方法：回顾性分析2012年5月至2014年10月在重庆医科大学附属儿童医院重症医学科治疗的中重型TBI患儿[入院格拉斯哥昏迷评分（Glasgow Coma Scale，GCS）≤13]的临床资料，采用多因素logistic回归分析中重型TBI患儿死亡的独立危险因素。将血糖>11.1 mmol/L定义为高血糖；双瞳孔不等大或瞳孔散大固定设定为瞳孔异常。结果：共109例患儿进入分析，21名患儿入院血糖>11.1 mmol/L。存活92例，死亡17例。死亡组患儿血糖水平、合并损伤率和入院瞳孔异常率明显高于存活组[（14.31±6.46） vs. （7.08±3.38），76.5% vs. 47.5%，88.2% vs. 7.6%；P=0.000，P=0.010，P=0.000]，而死亡组入院GCS评分低于存活组（4 vs. 9；P=0.000）。多因素logistic回归分析发现早期高血糖（OR=6.36，95%CI=1.20~33.68；P=0.029）、入院瞳孔异常（OR=17.09，95%CI=3.26~89.70；P=0.001）和入院GCS（OR=0.62，95%CI=0.39~1.00；P=0.048）是中重型TBI患儿死亡的独立危险因素；而合并其他脏器损伤（OR=1.20；95%CI=0.15~9.40；P=0.859）并不是此类患儿死亡的独立危险因素。结论：入院高血糖是中重型TBI患儿死亡的独立危险因素。

Abstract:

Objective：To explore the effect of early hyperglycemia on the mortality in children with moderate to severe traumatic brain injury（TBI）. Methods：This retrospective cohort study was conducted in Department of Critical Care Medicine，Children’s Hospital of Chongqing Medical University between May 2012 and October 2014，including patients with moderate to severe TBI[admission Glas－gow Coma Scale（GCS）≤13]. The clinical data were collected. Multivariate logistic regression was used to identify risk factors related to mortality. Hyperglycemia was defined as glucose>200 mg/dL （11.1 mmol/L）. Unequal pupils and fixed pupils were defined as ab－normal pupil reflex. Results：Totally 109 patients with median age of 54 months [interquartile range（IQR） 17 to 82] were enrolled. There were 92 survivals and 17 deaths in hospital. The admission blood glucose of 21 patients was higher than 11.1 mmol/L. The glu－cose level，combined injury and abnormal pupil reflex ratio of death group were significantly higher than those of survival group [（14.31±6.46） vs. （7.08±3.38），76.5% vs. 47.5%，88.2% vs. 7.6%，P=0.000，P=0.010，P=0.000]. Admission GCS is lower in death group than in survival group （4 vs. 9，P=0.000）. Multivariate logistic regression analysis showed that admission hyperglycemia（OR=6.36，95%CI=1.20 to 33.68；P=0.029），abnormal pupil reflex（OR=17.09，95%CI=3.26 to 89.70；P=0.001） and admission GCS（OR=0.62，95%CI=0.39 to 1.00；P=0.048） were independent risk factors for death in children with moderate or severe TBI. However，com－bined injury（OR=1.20，95%CI=0.15 to 9.40；P=0.859） was not an independent risk factor for death in this study. Conclusion：The admission hyperglycemia is an independent risk factor for the prediction of death for moderate to severe TBI in Children.