CAJ | 학술논문

目的：探讨蛛网膜下腔出血后血清游离脂肪酸浓度变化与迟发性脑缺血的关系。方法选取75例蛛网膜下腔出血患者，发病14 d内进行间接热量测定法检查全身耗氧量和液相色谱法测定游离脂肪酸浓度；应用多变量广义估计方程模型验证游离脂肪酸浓度与蛛网膜下腔出血的关系，Cox风险比例模型证实迟发性脑缺血的时间关系。结果75例蛛网膜下腔出血患者进行249项检查，发现n-6FFA和n-3FFA浓度与全身耗氧和改良的Fisher评分有关；21例（28％）患者出血后平均7 d发生迟发性脑缺血，迟发性脑缺血病人改良的Fisher评分，平均n-6FFA ：n-3FFA比例和平均耗氧量较高；在Cox风险比例模型中，平均n-6FFA ：n-3FFA比例、年轻和改良的Fisher评分与迟发性脑缺血的时间有关。结论蛛网膜下腔出血后脑损伤的严重性和耗氧代谢亢进与n-FFA浓度增高有关，n-6FFA ：n-3FFA比例增加与迟发性脑缺血有关，提示调节氧耗和FFA浓度能减少DCI发生。
목적：탐토주망막하강출혈후혈청유리지방산농도변화여지발성뇌결혈적관계。방법선취75례주망막하강출혈환자，발병14 d내진행간접열량측정법검사전신모양량화액상색보법측정유리지방산농도；응용다변량엄의고계방정모형험증유리지방산농도여주망막하강출혈적관계，Cox풍험비례모형증실지발성뇌결혈적시간관계。결과75례주망막하강출혈환자진행249항검사，발현n-6FFA화n-3FFA농도여전신모양화개량적Fisher평분유관；21례（28％）환자출혈후평균7 d발생지발성뇌결혈，지발성뇌결혈병인개량적Fisher평분，평균n-6FFA ：n-3FFA비례화평균모양량교고；재Cox풍험비례모형중，평균n-6FFA ：n-3FFA비례、년경화개량적Fisher평분여지발성뇌결혈적시간유관。결론주망막하강출혈후뇌손상적엄중성화모양대사항진여n-FFA농도증고유관，n-6FFA ：n-3FFA비례증가여지발성뇌결혈유관，제시조절양모화FFA농도능감소DCI발생。
Objective To explore the relation between in serum free fatty acid levels changes and delayed cerebral ischemia after subarachnoid hemorrhage.Methods In 75patients with subarachnoid hemorrhage ,we performed measurement of system oxygen consumption by indirect calorimetry and free fatty acid levels by liquid chromatography in the first 14days after ic-tus.Multivariable generalized estimating equation models identified associations with free fatty acid levels and subarachnoid hemorrhage.Cox proportional hazards model was used to identify associations with time to delayed cerebral ischemia.Results There were 249 measurements in 75 patients with subarachnoid hemorrhage ,and n-6FFAand n-3FFA levels were found to be associated with oxygen consumption and the modified Fisher score.Twenty one (28% ) patients developed delayed cerebral is-chemia on median 7days after subarachnoid hemorrhage.In patients who developed delayed cerebral ischemia the modified Fisher score ,mean n-6FFA :n-3FFA ratio mean oxygen consumption level were higher.In a Cox proportional hazards model ,the mean n-6FFA :n-3FFA ratio ,younger age and modified Fisher score were associated with time to delayed cerebral ischemia.Conclusion Injury severity and oxygen consumption hypermetabolish after subarachnoid hemorrhage are associated with higher n-FFA levels ,and increased n-6FFA :n-3FFA ratio is associated with delayed cerebral ischemia.This may suggest that modulating both oxygen consumption and FFA levels can reduce the occurrence of delayed cerebral ischemia.