The Clinical Study Of HHNC Complicated By Moderate And Severe Head Injury

Objective To explore the pathogenesis, clinical features, diagnosis, treatment and prognosis of moderate or severe craniocerebral injury complicated by hyperosmolar hyperglycemic nonketotic coma (HHNC), so as to provide the scientific theory to apply more reasonable and effective management, which will increase the cure rate, and reduce morbality and mortality rate.Methods Patients with moderate or severe craniocerebral injury accompanied by HHNC, treated in our hospital between June 2000 and December 2006, were analyzed retrospectively. The diagnostic criteria of HHNC consisted of:①Obvious neuro-psychologic symptoms and signs, especially progressing conscious disturbance;②dehydration and hypovolemia, pachyemia (RBC, HGB, HCT and WBC all increased);③Subarachnoid hemorrhage and delayed intracranial hematoma secondary to HHNC usually, because of the deprivation of intracellular fluids and decrease of intracranial pressure, resulting in the damage of the bridging veins;④Laboratory examination: the serum glucose value > 33.3 mmol/L; the serum sodium > 150mmol/L; the serum potassium decreasing mostly; plasma osmotic pressure > 350mmol/L; strong positive urine glucose; negative or weakly positive urine acetone bodies. According to GCS scores on admission, 26 patients, confirmed with moderate or severe craniocerebral injury accompanied by HHNC, were divided into three group: moderate injury group (GCS 9-12), 7 cases; severe injury group(GCS 6-8), 13 cases; and critical craniocerebral injury group (GCS 3-5), 6 cases. The serum glucose, serum electrolyte, plasma osmotic pressure, liver and renal function and urine routine were measured on admission, 2ed, 3rd and 7th day, combined therapy was applied, and therapeutic efficacy and prognosis were observed.Results In 26 patients, the lower GCS scores, the higher serum glucose and the worse prognosis, the serum glucose of the three group on admission was 11.82±3.14, 8.89±2.64, 7.98±2.32mmol/L, and significant difference was observed between the serum glucose levels and both GCS scores and the prognosis. The mortality rate of the patients whose serum glucose was higher than 22 mmol/L increased obviously. According to GOS scores one month after injure, 26 patients were divided into three groups: good recovery including recovery and moderate neurological deficit), 7 cases; bad recovery group including severe neurological deficit and vegetative survival, 8 cases; and dead, 11 cases, with a mortality of 42.3%. 9 cases whose serum glucose on admission were higher than 26.6 mmol/L, 3 cases died of primary craniocerebral injury, 3 cases died of uncontrolled hyperglycemic hyperosmolar condition accompanied with respiratory and circulatory failure, 2 cases died of multiple organ function failure after operation, 2 cases died of shock with electrolyte disturbances because of hypothalamus damaged, and one died of a large area of brain infarction postoperation.Conclusions The early diagnosis and effective combined therapy is the key to reduce the mortality of moderate or severe craniocerebral injury accompanied by HHNC. The GCS scores and the level of serum glucose is the important factors of the prognosis, and the lower GCS scores, together with the higher serum glucose, and with the longer persistence time, and the poorer the prognosis.