范力

[摘要] 目的 探讨空腹血糖（fasting plasma glucose，FPG）与糖化血红蛋白（glycosylated hemoglobin A1c，HbA1c）检测在重症颅脑外伤急性期病情评估及预后判断中的应用价值。 方法 随机选取2012年12月～2014年12月期间我院收治的40例颅脑损伤患者，根据患者入院时的格拉斯哥昏迷指数评分将其分为重度颅脑外伤患者（观察组）和轻度颅脑外伤患者（对照组），每组各20例，分别对其进行空腹血糖（FPG）、糖化血红蛋白（HbA1c）的检测，对比分析两组患者的FPG水平和HbA1c水平与患者急性期病情评估及预后判断的关系。 结果 观察组的平均空腹血糖水平明显高于对照组，糖化血红蛋白水平较高的颅脑外伤患者病死率明显高于糖化血红蛋白水平低者（P<0.05）。 结论 重度颅脑外伤患者急性期的空腹血糖及糖化血红蛋白水平是判断其颅脑损伤严重程度的重要参考指标，也为患者的预后判断提供了较准确的数据指标，具有良好的参考价值。

[关键词] FPG；HbA1c；颅脑损伤；病情评估；预后判断；参考价值

[中图分类号] R651.1 [文献标识码] B [文章编号] 1673-9701（2015）35-0095-04

[Abstract] Objective To explore and analyze the application value of fasting blood glucose（FPG） detection and glycosylated hemoglobin A1c （HbA1c） detection in assessment and prognosis of severe traumatic brain injury at acute stage. Methods A total of 40 cases of patients with traumatic brain injury who were admitted to our hospital from December 2012 to December 2014， were randomly selected， according to the Glasgow Coma Scale score on admission， and they were divided into severe traumatic brain injury patients group and mild traumatic brain injury patients group， each group with 20 cases. Fasting plasma glucose（FPG） and glycosylated hemoglobin（HbA1c） were conducted in patients of the two groups respectively， and the relationship between FPG levels and HbA1c levels of patients in the two groups and assessment and prognosis of patients with severe traumatic brain injury at acute stage was compared and analyzed. Results The mean fasting plasma glucose levels（FPG） in patients with severe traumatic brain injury were significantly higher than those in patients with mild traumatic brain injury， and mortality of high glycated hemoglobin levels in patients with traumatic brain injury was significantly higher than that in patients with low hemoglobin levels（P<0.05）. Conclusion Fasting blood glucose and glycated hemoglobin levels are important reference index to determine the severity of brain injury for severe brain injury patients at acute stage， but also provide a more accurate indicator for the prognosis of patients， and have good reference value.

[Key words] FPG； HbA1c； Traumatic brain injury； Disease assessment； Prognosis； Reference value

近年來，由于交通事故、意外伤害等因素造成的颅脑损伤日益增多，颅脑损伤已经成为临床诊疗中常见的疾病之一，颅脑损伤主要是由于受到强大外力作用而引起的脑组织损伤，病情发展迅速，具有较高的致残率和死亡率[1]。据相关统计数据显示，我国颅脑损伤患者发病率呈现逐年上升的趋势，颅脑损伤给患者的身体和心理带来巨大的冲击，对其生存质量造成严重影响，因此，如何及时对患者的病情及预后进行准确的评估判断是当前临床医生面临的重要课题[2，3]。重度颅脑损伤患者的早期应激性会引起体内儿茶酚胺水平迅速升高，进而导致其血糖浓度增加。由于高血糖状态下，机体脑细胞处于无氧代谢过程，将进一步加重脑损伤症状，对患者的中枢神经功能造成一定影响，因此，重症颅脑损伤患者血糖水平的高低与其预后有直接相关[4，5]。……