Hyperglycemia, intracranial pressure and prognosis of patients with severe craniocerebral injury

Aim: To study the association of hyperglycemia with severity of disease, intracranial pressure and prognosis after severe craniocerebral injury. Methods: Totally 284 patients suffering from severe craniocerebral injury were treated in the Department of Neurosurgery, Tangdu Hospital of Fourth Military Medical University of Chinese PLA from September 2001 to August 2003. All patients were hospitalized within 12 hours of onset and received no liquid containing sugar. They were divided into epidural hematom (n = 98), acute subdural hematoma (n = 67) and intracerebral hematoma groups (n = 119) according to the CT result on hospitalization, 3 or 4 score group (n = 78), 5 or 6 score (n = 85) and 7 or 8 score group (n = 121) based on Glasgow coma scoring. All patients received surgical intervention and intracranial pressure was detected by using an epidural intracranial pressure measuring system. The level of serum glucose was examined on hospitalization and after operation. The patients were divided into two groups according to Glasgow coma score after 6 months: good effect group (≥ 4 scores) and bad effect group (≤ 3 scores). The results were compared in combination with severity of injury, intracranial pressure and intracranial pressure accordingly. Results: All 284 patients were involved in the result analysis. 1 The level of serum glucose on hospitalization and after operation increased in 3 or 4 score group as compared with that in 7 or 8 score group [(12.0 ± 0.8), (11.4 ± 0.5), (10.2 ± 0.6), (9.7 ± 0.8) mmol/L, P < 0.05]. There was no significant difference in the level of serum glucose on hospitalization and after operation in each group (P > 0.05). 2 The result of CT indicated there was no significant difference in the level of serum glucose on hospitalization and after operation in epidural hematom, acute subdural hematoma and intracerebral hematoma groups (P > 0.05). 3 The level of serum glucose was higher in bad effect group than that in good effect group on hospitalization and after operation [(11.8 ± 0.5) vs (9.8 ± 0.5), (11.5 ± 0.4) vs (8.1 ± 0.3) mmol/L, P < 0.01]. 4 There was no significant association between intracranial pressure and the level of serum glucose on hospitalization, however, maximum intracranial pressure was associated with the level of serum glucose within 24 hours after operation (r = 0.383, P < 0.01); the higher the level of serum glucose was, the higher the intracranial pressure was. Conclusion: The level of serum glucose is associated with the severity of injury, intracranial pressure and therapeutic efficacy. Hyperglycemia indicates serious disease. After operation, the higher the level of serum glucose and the intracranial pressure are, the worse the therapeutic efficacy and the prognosis are. The level of serum glucose is a significant indicator on severity head injury, and a reliable predictor of prognosis.