作者：董宇为，黄喆，孙立鹏，冯波，魏小兵，王喆，李荣伟，柳亚岐

单位：

Department of Neurosurgery Ward 2, Hanzhong Center Hospital, Hanzhong 723000, China Corresponding author: DONG Yuwei, E-mail: dyw0915@163.com

单位（英文）：

723000陕西省汉中市中心医院神经外科二病区 通信作者：董宇为，E-mail：dyw0915@163.com

关键词：

颅脑损伤; 血糖; 应激性高血糖; 认知功能障碍;

关键词（英文）：

Craniocerebral trauma; Blood glucose; Stress hyperglycemia; Cognitive dysfunction

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.312

基金项目：

陕西省中医脑病临床医学研究中心建设项目（2022LCZX-02）；陕西省汉中市中心医院院级科研基金项目（YK1827）

摘要：

目的 探讨应激性高血糖对中型创伤性颅脑损伤患者认知功能障碍的影响。方法 选取2020年8月至2021年10月于汉中市中心医院神经外科住院治疗的中型创伤性颅脑损伤患者97例。将发生应激性高血糖的患者作为观察组（n=55），未发生应激性高血糖的患者作为对照组（n=42），然后按照入组顺序将观察组患者随机分为观察A亚组（n=27）和观察B亚组（n=28）。对照组给予止血、预防癫痫、营养神经等颅脑损伤后常规治疗，有手术指征的患者给予开颅手术。观察组在对照组治疗基础上采用强化胰岛素治疗方案。观察A亚组目标血糖控制在6.1～8.0 mmol/L，观察B亚组目标血糖控制在8.1～11.1 mmol/L。比较观察组与对照组及观察A亚组与观察B亚组认知功能障碍发生率和简易精神状态检查量表（MMSE）评分。采用多因素Logistic回归分析探讨中型创伤性颅脑损伤患者发生认知功能障碍的影响因素。结果 本研究共剔除14例患者，其中对照组5例、观察A亚组4例、观察B亚组5例，最终共纳入83例患者。观察组认知功能障碍发生率为32.6%(15/46)，高于对照组的13.5%(5/37)(P<0.05)。观察组MMSE总分低于对照组（P<0.05）。观察A亚组认知功能障碍发生率为30.4%(7/23)，与观察B亚组的34.8%(8/23)比较，差异无统计学意义（P>0.05）；观察B亚组语言能力评分低于观察A亚组（P<0.05）。多因素Logistic回归分析结果显示，应激性高血糖为中型创伤性颅脑损伤患者发生认知功能障碍的危险因素（P<0.05）。结论 应激性高血糖是中型颅脑损伤患者发生认知功能障碍的危险因素，而将发生应激性高血糖患者的血糖控制在6.1～8.0 mmol/L可以改善其语言能力。

英文摘要：

【Abstract】　Objective To investigate the effect of stress hyperglycemia on cognitive dysfunction in patients with moderate traumatic brain injury. Methods A total of 97 patients with moderate traumatic brain injury hospitalized in Department of Neurosurgery of Hanzhong Central Hospital from August 2020 to October 2021 were selected. The patients with stress hyperglycemia were selected as the observation group (n=55) , and the patients without stress hyperglycemia were selected as the control group ( n=42) . The observation group was randomly divided into observation subgroup A (n=27) and observation subgroup B ( n=28) according to the order of inclusion. The control group was given routine treatment after craniocerebral injury such as hemostasis, prevention of epilepsy and nutritional nerve, and the patients with surgical indications were given craniotomy. The observation group received intensive insulin therapy on the basis of the treatment plan of the control group. The target blood glucose in observation subgroup A was controlled at 6.1-8.0 mmol/L, and the target blood glucose in observation subgroup B was controlled at 8.1-11.1 mmol/L. The incidence of cognitive dysfunction and Mini-Mental State Examination (MMSE) score were compared between observation group and control group, observation subgroup A and observation subgroup B. Multivariate Logistic regression analysis was used to investigate the influencing factors of cognitive dysfunction in patients with moderate traumatic brain injury. Results A total of 14 patients were excluded in this study, including 5 patients in the control group, 4 patients in subgroup A and 5 patients in subgroup B, and a total of 83 patients were finally included. The incidence of cognitive dysfunction in the observation group was 32.6% (15/46) , which was higher than 13.5% (5/37) in the control group (P < 0.05) . The MMSE total score of the observation group was lower than that of the control group (P < 0.05) . There was no significant difference in the incidence of cognitive dysfunction between observation subgroup A [30.4% (7/23) ] and observation subgroup B [34.8% (8/23) ] ( P > 0.05) . The score of language ability in observation subgroup B was lower than that in observation subgroup A (P < 0.05) . Multivariate Logistic regression analysis showed that stress hyperglycemia was a risk factor of cognitive dysfunction in patients with moderate traumatic brain injury (P < 0.05) . Conclusion Stress hyperglycemia is a risk factor of cognitive dysfunction in patients with moderate traumatic brain injury, and controlling the blood sugar within 6.1 to 8.0 mmol/L in patients with stress hyperglycemia can improve the language ability of patients.

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