Abstract: Background　Hyperglycemia with unknown mechanism plays a predictive role in determining the prognosis of patients with multiple trauma.However，the time of blood sugar measurement and the role of blood sugar changes in the monitoring of these patients have not been well reported.Objective　To explore the relationship between the blood sugar level at admission （BS） and the blood sugar level at 3 hours after admission （BS3），the difference between them （ΔBS） and their relationship with in-hospital mortality.Methods　Patients with multiple trauma who came to the Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital from September 2015 to September 2017 were selected.After admission，patients were assessed according to Advanced Traumatic Life Support （ATLS）guidelines，and emergency treatment measures were taken.Gender，age，hospital mortality，injury site，vital signs，injury severity score （ISS） and revised trauma score （RTS） were recorded.Blood samples were sent to the laboratory for emergency examination within 20 minutes after admission.The hemoglobin，hematocrit （HCT），BS，BS3，ΔBS，international normalized ratio （INR），lactic acid and base excess （BE） were recorded.Univariate and multivariate Cox proportional hazard regression model was used to analyze the influencing factors of in-hospital mortality in patients with multiple injuries.Results　There were 963 patients with multiple injuries，683 of whom were excluded and 280 were enrolled in the group.Among them，18 cases （6.4%） died in hospital．Multivariate Cox proportional hazard regression analysis showed that：heart rate 〔HR=4.297，95%CI（1.277，14.458）〕，ΔBS 〔HR=2.910，95%CI（1.477，5.733）〕，INR 〔HR=2.228，95%CI（1.346，3.687）〕 were independent influencing factors of hospital mortality in patients with multiple injuries in emergency department （P<0.05）.Conclusion　For patients with multiple trauma，ΔBS maybe helpful in predicting hospital mortality，but further large sample studies are needed.In addition，tachycardia may and coagulation dysfunction increase hospital mortality.

Key words: Wounds and injuries；Multiple injuries；Blood glucose；Hospital mortality；Emergency service, hospital

摘要： 背景　机制不明的高血糖对多发伤患者的预后具有预测作用，但血糖测量的时间和血糖水平变化在监测多发伤患者中的作用尚未见相关报道。目的　探讨急诊多发伤患者入院时血糖（BS）水平和入院后3 h血糖（BS3）水平，以及其之间的差值（ΔBS）与院内死亡率的关系。方法　选取2015年9月—2017年9月在中南大学湘雅医学院附属海口医院急诊科就诊的多发伤患者作为研究对象。入院后根据高级创伤生命支持（ATLS）指南评估患者后，采取相应的急诊处理措施，记录患者的性别、年龄、院内死亡情况、受伤部位、生命体征、创伤严重程度评分（ISS）、改良创伤评分（RTS）。并将受试者入院后20 min内的血液样本送至实验室急查，记录患者入院时的血红蛋白、红细胞比容（HCT）、BS、BS3、ΔBS、国际标准化比值（INR）、乳酸、剩余碱（BE）。采用单因素和多因素Cox比例风险回归模型分析多发伤患者院内死亡情况的影响因素。结果　共有963例多发伤患者，其中683例患者被排除在外，280例患者入组。280例患者中，院内死亡18例（6.4％）。多因素Cox比例风险回归模型分析结果显示，心率〔HR=4.297，95%CI（1.277，14.458）〕、ΔBS〔HR=2.910，95%CI（1.477，5.733）〕、INR〔HR=2.228，95%CI（1.346，3.687）〕是急诊多发伤患者院内死亡的独立影响因素（P<0.05）。结论　对于多发伤患者，ΔBS可能有助于预测院内死亡率，但仍需要大样本的研究来进一步验证。而心动过速和凝血功能障碍可能会增加患者的院内死亡率。

关键词: 创伤和损伤, 多发伤, 血糖, 医院死亡率, 急诊室, 医院