A Study Of Monitoring Of Blood Glucose And The Effect Of Mild Hypothermia In Patients With Severe Head Injury

Objective:To explore the changes of blood glucose and the relationship between blood glucose level and prognosis in patients with severe brain injury , as well as the effect of mild hypothermia on it.Methods:36 patients with severe traumatic brain injury were divided in to normothermic group (20) and mild hypothermia group (16).The trache otomy was used immediately on the patients in the mild hypothermia group after the admission or emergent surgery. At the same time the mild hypothermia-hibernation were used for 3-5 days .We use medical blanket to decrease the patients, temperature on the head or back.The temperature on the medical blanket, surface was 14℃and the therapeutic temperature was 33-35℃(anal temperature).The hibernation mixture(Wintermin and Promethazine) were used continuously by micro-injection pump at 0.14mg/Kg*h.If the patients chill or restlessness ,the 10mg diazepam should be given by vein.At the first,if the temperature can,t be controlled satisfactori ly,we can accelerate the speed of hibernation mixture to 0.16 mg/Kg*h untill the body temperature, pulse, respiration, blood pressure of the patients were good and the muscle was relaxed.If the patients have respiratory dysfunction,the ventilator and muscle relaxants may be used. At the same time the dehydration, antibiotic, trophicnervean d,suppressing the gastric juice secretion and so on were adopted on patients in mild hypothermia group.The patients in the conventional therapy were treated by con ventional therapy as the same as the mild hypothermia group. The levels of blood glucose were mesured on admission and the second day,third day, fifth day, seventh day after admission in both groups,and the treatment effect and prognosis were observed by GLasgow Outcome Scale(GOS).We used 2 ml venous blood that gathered from patients in early morning to masure the blood glucose by glucose oxydases law.And the reference value was 3.9-6.1mmol/L.At last the relationship between the levels of blood glucose and prognosis and the relationship between the levels of blood glucose and condition were analyzed,as well as the difference of blood glucose and prognosis between two groups.Results:The level of blood glucose on admission is significantly correlative with GCS(P<0.05), in the normothermic group,the two groups f patients whose GCS are≤5 and 6-8 scores have the admitted blood glucose level of 11.67±2.78mmol/L and 9.21±2.43mmol/L,correspondingly, the admitted blood glucose level are 11.34±2.61 mmol/L and 9.37±2.21mmol/L in the mild hypothermia group .The level of blood glucose on admission is significantly correlative with prognosis(P<0.05 ),The three groups of patients whose prognosis are good, vegetative status or dead have the corresponding blood glucose levels of 8.43±1.26,11.63±2.03,12.52±2.78mmol/L。while in the mild hypothermia group,the blood glucose levels are 8.52±1.30,11.35±1.97,12.61±2.92mmol/L. The blood glucose levels between the normothermic group and the mild hypothermia group are obviously different in different peroids,the good outcome was achieved 4(4/20) patients,moderate disability in 5(5/20),severe disability in 1(1/20) and vegetative subsistence in 2(2/20) and 8patients died(8/20),and in the mild hypothermia group 43.75%(7/16) were good, 25%(4/ 16)moderately disabled,12.5%(2/16)severely disabl ed and 7.25% (1/16)vegetative subsistence and 12.5%(2/16)died.There was significant difference in prognosis between two groups.Concluions:1) The blood glucose of Patients with severe brain injury has increased in acute phase.The hyperglycemia obviously enhance the density of glucose in the brain organization. Than the massive glucose zymolysis without enough oxygen and the lactic acid accumulation aggravate the neuron inside connection plastochondria swelling and the destruction.The level of the blood glucose can represent theseverity of head injury , therefore may take it as the target of the degree of head injury. 2)The higher the blood glucose,the longer the duration,the more serious the injury,the worse the prognosis. The relationship between the level of the blood glucoser and the degree of the head injury is so closely. If we synthetically analysis the blood glucose change in patients with heavy head injury ,generalizecondition whether to change for the better related,it may be helping to appraises the prognosis. 3)However,the mild hypothermia can significantly inhibit hyperglycemia and improve prognosis in patients with severe craniocerebral injury.4)The blood glucose monitoring,which is accurately, fast,simple,easy,low cost to use,accurately responds extent of injury in patiens with severe head injury.Its use is inportant for improving the care ,prognosis and management of patients with severe head injury.