关键词: 颅脑损伤, 应激性高血糖, 乳酸清除率

Abstract: Objective  To explore the clinical significance of stress-induced hyperglycemia (SIH) combined with early lactate clearance rate (LCR) in the prognosis of patients with severe traumatic brain injury (TBI).  
Methods  Clinical data of 81 severe TBI patients were collected and divided into good prognosis group and poor prognosis group according to the survival within 28 d. The general data, occurrence of SIH and early LCR of the two groups were compared. The influencing factors of poor prognosis of severe TBI patients were analyzed by Logistic regression analysis, and the clinical value of SIH combined with early LCR for prognosis of patients was analyzed according to receiver operating characteristic (ROC) curve. 
Results  Among 81 severe TBI patients, 36 survived and 45 died within 28 d, with a fatality rate of 55.56%. The Glasgow coma scale (GCS) score, blood oxygen saturation and early LCR in the poor prognosis group were lower than those in the good prognosis group, while the incidence of cerebral hernia, the incidence of SIH and the duration of coma were higher than those in the good prognosis group (P＜0.05). Logistic regression analysis showed that GCS score, cerebral hernia occurrence, SIH, blood oxygen saturation, duration of coma, and early LCR were risk factors for poor prognosis in severe TBI patients (P＜0.05). ROC analysis showed that the area under the ROC curve (AUC) of early LCR in predicting the prognosis of severe TBI patients was 0.764, and that of SIH in predicting the prognosis of severe TBI patients was 0.761. The AUC of the combined detection in prediction was 0.900, which was higher than that of the early LCR or SIH alone. 
Conclusion  SIH and early LCR are closely related to the prognosis of severe TBI patients, and their combination has certain clinical value in predicting the prognosis of patients. 

Key words: traumatic brain injury, stress hyperglycemia, lactate clearance rate