重度脑创伤患者血浆游离肉碱水平的变化及其与预后的关系研究
摘要
目的探讨重度脑创伤患者血浆游离肉碱水平的变化及其与预后的关系。方法选取2015年1月-2017年1月本院收治的80例重度脑创伤患者作为研究对象,选取同期体检的健康人群作为对照组(n=80),分别于患者受伤后12、24 h、2、3及5 d检测血浆游离肉碱水平。比较2组患者、不同预后患者的血浆游离肉碱水平,并分析血浆游离肉碱水平与预后的关系,比较不同血浆游离肉碱水平的重度创伤性脑损伤患者的相关资料,并采用Logistic多因素模型分析重度创伤性脑损伤患者低血浆游离肉碱水平的危险因素。结果重度脑创伤患者伤后12、24 h、伤后2、3及5 d血浆游离肉碱水平均低于对照组(P<0.05);预后良好组患者伤后血浆游离肉碱水平显著增高(P<0.05),预后良好组患者伤后12、24 h、伤后2、3及5 d血浆游离肉碱水平均高于预后不良组(P<0.05),重度创伤性脑损伤患者血浆游离肉碱水平与预后呈负相关(r=-0.423,P=0.005);游离肉碱<18μmmol/L组患者BMI、GCS评分及血尿素水平显著低于游离肉碱≥18μmmol/L组(P<0.05),游离肉碱<18μmmol/L组患者平均动脉压、肾小球滤过率及多发伤合并脑创伤显著高于游离肉碱≥18μmmol/L组(P<0.05);Logistic多因素分析显示肾小球滤过率及多发伤合并脑创伤是重度创伤性脑损伤患者低血浆游离肉碱水平的影响因素(P<0.05)。结论重度脑创伤患者血浆游离肉碱水平显著增高,并与预后呈负相关,肾小球滤过率及多发伤合并脑创伤是重度创伤性脑损伤患者低血浆游离肉碱水平的影响因素。
引文
[1]弓开弦.影响急性颅脑损伤患者预后的相关因素分析[J].临床医学研究与实践,2017,2(14):12-13.
[2]谭杨劲,文世宏,李雪松.急性颅脑损伤患者血清IL-6水平与病情及预后的关系研究[J].河南医学研究,2017,26(5):830-831.
[3]Flanagan JL,Simmons PA,Vehige JA,et al.Role of carnitine in disease[J].Nutr Metab(Lond),2010,7(1):30.
[4]Heyland D,Muscedere J,Wischmeyer PE,et al.A randomized trial of glutamine and antioxidants in critically ill patients[J].N Engl J Med,2013,36(8):1489-1497.
[5]Minville V,Asehnoune K,Ruiz S,et al.Increased creatinine clearance in polytrauma patients with normal serum creatinine:a retrospective observational study[J].Critical Care,2011,15(1):R49.
[6]郑金玉,齐亮,韩辉,等.创伤性脑损伤UCH-L1水平与损伤程度、病情变化及预后的相关性分析[J].中华神经医学杂志,2015,14(7):703-706.
[7]Lefrant JY,Hurel D,Cano NJ,et al.Guidelines for nutrition support in critically ill patient[J].Annales Francaises Danesthesie Et De Reanimation,2014,28(2):202-218.
[8]张忠霞,张宏,崔冬生,等.左旋肉碱对大鼠缺血性脑损伤的神经保护作用[J].山东大学学报(医学版),2012,50(8):14-19.
[9]Scafidi S,Racz J,Hazelton J,et al.Neuroprotection by AcetylL-Carnitine after traumatic injury to the immature rat brain[J].Dev Neurosci,2010,32(5/6):480-487.
[10]李坚,赵小朋,廖金花,等.早产儿血游离肉碱与脑损伤相关性的研究[J].广州医药,2013,44(3):7-9.
[11]Rebouche CJ.Kinetics,pharmacokinetics,and regulation of L-carnitine and acetyl-L-carnitine metabolism[J].Ann N Y Acad Sci,2004,1033(1):30-41.
[12]Hasenboehler E,Williams A,Leinhase I,et al.Metabolic changes after polytrauma:an imperative for early nutritional support[J].World Journal of Emergency Surgery,2006,1(1):29.
[13]Doig GS,Heighes PT,Simpson F,et al.Early enteral nutrition,provided within 24 h of injury or intensive care unit admission,significantly reduces mortality in critically ill patients:a meta-analysis of randomised controlled trials[J].Intensive Care Med,2009,35(12):2018-2027.
[14]Seron-Arbeloa C,Puzo-Foncillas J,Garces-Gimenez T,et al.Aretrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting[J].Clinical Nutrition,2011,30(3):346-350.
[15]高健群,马颖,江剑辉,等.窒息新生儿血肉碱谱与脑损伤相关性的研究[J].中国妇幼保健,2012,27(29):4543-4546.
[16]Preiser JC,Ichai C,Orban JC,et al.Metabolic response to the stress of critical illness[J].Br J Anaesth,2014,113(6):945-954.
[2]谭杨劲,文世宏,李雪松.急性颅脑损伤患者血清IL-6水平与病情及预后的关系研究[J].河南医学研究,2017,26(5):830-831.
[3]Flanagan JL,Simmons PA,Vehige JA,et al.Role of carnitine in disease[J].Nutr Metab(Lond),2010,7(1):30.
[4]Heyland D,Muscedere J,Wischmeyer PE,et al.A randomized trial of glutamine and antioxidants in critically ill patients[J].N Engl J Med,2013,36(8):1489-1497.
[5]Minville V,Asehnoune K,Ruiz S,et al.Increased creatinine clearance in polytrauma patients with normal serum creatinine:a retrospective observational study[J].Critical Care,2011,15(1):R49.
[6]郑金玉,齐亮,韩辉,等.创伤性脑损伤UCH-L1水平与损伤程度、病情变化及预后的相关性分析[J].中华神经医学杂志,2015,14(7):703-706.
[7]Lefrant JY,Hurel D,Cano NJ,et al.Guidelines for nutrition support in critically ill patient[J].Annales Francaises Danesthesie Et De Reanimation,2014,28(2):202-218.
[8]张忠霞,张宏,崔冬生,等.左旋肉碱对大鼠缺血性脑损伤的神经保护作用[J].山东大学学报(医学版),2012,50(8):14-19.
[9]Scafidi S,Racz J,Hazelton J,et al.Neuroprotection by AcetylL-Carnitine after traumatic injury to the immature rat brain[J].Dev Neurosci,2010,32(5/6):480-487.
[10]李坚,赵小朋,廖金花,等.早产儿血游离肉碱与脑损伤相关性的研究[J].广州医药,2013,44(3):7-9.
[11]Rebouche CJ.Kinetics,pharmacokinetics,and regulation of L-carnitine and acetyl-L-carnitine metabolism[J].Ann N Y Acad Sci,2004,1033(1):30-41.
[12]Hasenboehler E,Williams A,Leinhase I,et al.Metabolic changes after polytrauma:an imperative for early nutritional support[J].World Journal of Emergency Surgery,2006,1(1):29.
[13]Doig GS,Heighes PT,Simpson F,et al.Early enteral nutrition,provided within 24 h of injury or intensive care unit admission,significantly reduces mortality in critically ill patients:a meta-analysis of randomised controlled trials[J].Intensive Care Med,2009,35(12):2018-2027.
[14]Seron-Arbeloa C,Puzo-Foncillas J,Garces-Gimenez T,et al.Aretrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting[J].Clinical Nutrition,2011,30(3):346-350.
[15]高健群,马颖,江剑辉,等.窒息新生儿血肉碱谱与脑损伤相关性的研究[J].中国妇幼保健,2012,27(29):4543-4546.
[16]Preiser JC,Ichai C,Orban JC,et al.Metabolic response to the stress of critical illness[J].Br J Anaesth,2014,113(6):945-954.