中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
12期
890-894
,共5页
周昭雄%邱春芳%陈传希%王陆豪%陈娟%陈敏英%管向东%欧阳彬
週昭雄%邱春芳%陳傳希%王陸豪%陳娟%陳敏英%管嚮東%歐暘彬
주소웅%구춘방%진전희%왕륙호%진연%진민영%관향동%구양빈
血清肉毒碱%重症%病情严重程度%总胆红素%住院时间
血清肉毒堿%重癥%病情嚴重程度%總膽紅素%住院時間
혈청육독감%중증%병정엄중정도%총담홍소%주원시간
Serum carnitine%Critically ill%Disease severity%Total bilirubin%Hospital day
目的：探讨重症患者血清肉毒碱缺乏的相关因素及其对住院时间的影响。方法采用前瞻性观察性研究方法，收集2013年3月至9月中山大学附属第一医院重症医学科收治的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分＞12分的重症患者，测定入院时血清肉毒碱浓度和器官功能等指标，记录5 d内肠内营养耐受情况、总住院时间、重症监护病房（ICU）住院时间、院内病死率，分析其对血清肉毒碱浓度的影响及相关性。结果共入选30例重症患者，入院时血清肉毒碱浓度下降至（8.92±5.05）μmol/L（正常参考值43.5μmol/L）。入院时APACHEⅡ评分＞23分者（7例）血清肉毒碱较APACHEⅡ评分12～23分者（23例）明显降低（μmol/L：5.33±1.72比10.02±5.24，t＝2.300，P＝0.001），血清总胆红素（TBil）＞19μmol/L者（9例）血清肉毒碱较TBil≤19μmol/L者（21例）明显降低（μmol/L：5.54±2.70比9.84±5.08，t＝2.750，P＝0.014）；血清肉毒碱浓度与APACHEⅡ评分、血清TBil呈明显负相关（r＝-0.387，P＝0.035；r＝-0.346，P＝0.048）。5 d观察期内，肠内喂养总量为（5134±1173）mL，血清肉毒碱浓度与肠内喂养总量呈明显正相关（r＝0.430， P＝0.022）。30例患者中，腹胀发生率为40.0%（12/30），腹胀组血清肉毒碱浓度较非腹胀组稍低（μmol/L：7.83±4.98比9.12±5.35，t＝0.707，P＝0.383）；腹泻发生率为26.7%（8/30），腹泻组血清肉毒碱浓度较非腹泻组稍低（μmol/L：8.27±5.78比9.73±4.78，t＝0.607，P＝0.576）。总住院时间为（34.72±16.66）d，住院时间≥45 d者（8例）血清肉毒碱浓度较＜45 d者（22例）明显降低（μmol/L：5.71±3.23比9.95±5.26，t＝1.627，P＝0.020）；但血清肉毒碱浓度与总住院时间无相关性（r＝-0.165，P＝0.385）。ICU住院时间为（18.60±10.72）d， ICU住院时间＞7 d者（27例）血清肉毒碱浓度较≤7 d者（3例）略有降低（μmol/L：8.44±5.00比13.24±3.65， t＝1.610，P＝0.119）；血清肉毒碱浓度与ICU住院时间无相关性（r＝-0.019，P＝0.293）。住院病死率26.67%（8/30），死亡组与存活组血清肉毒碱无差异（μmol/L：12.24±6.52比7.72±3.91，t＝-1.846，P＝0.098）；且血清肉毒碱浓度与住院病死率无相关性（r＝0.340，P＝0.066）。结论重症患者血清肉毒碱浓度明显下降，血清肉毒碱浓度与病情严重程度、血清TBil浓度相关；血清肉毒碱浓度较低的患者肠内喂养总量减少，住院时间延长。
目的：探討重癥患者血清肉毒堿缺乏的相關因素及其對住院時間的影響。方法採用前瞻性觀察性研究方法，收集2013年3月至9月中山大學附屬第一醫院重癥醫學科收治的急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分＞12分的重癥患者，測定入院時血清肉毒堿濃度和器官功能等指標，記錄5 d內腸內營養耐受情況、總住院時間、重癥鑑護病房（ICU）住院時間、院內病死率，分析其對血清肉毒堿濃度的影響及相關性。結果共入選30例重癥患者，入院時血清肉毒堿濃度下降至（8.92±5.05）μmol/L（正常參攷值43.5μmol/L）。入院時APACHEⅡ評分＞23分者（7例）血清肉毒堿較APACHEⅡ評分12～23分者（23例）明顯降低（μmol/L：5.33±1.72比10.02±5.24，t＝2.300，P＝0.001），血清總膽紅素（TBil）＞19μmol/L者（9例）血清肉毒堿較TBil≤19μmol/L者（21例）明顯降低（μmol/L：5.54±2.70比9.84±5.08，t＝2.750，P＝0.014）；血清肉毒堿濃度與APACHEⅡ評分、血清TBil呈明顯負相關（r＝-0.387，P＝0.035；r＝-0.346，P＝0.048）。5 d觀察期內，腸內餵養總量為（5134±1173）mL，血清肉毒堿濃度與腸內餵養總量呈明顯正相關（r＝0.430， P＝0.022）。30例患者中，腹脹髮生率為40.0%（12/30），腹脹組血清肉毒堿濃度較非腹脹組稍低（μmol/L：7.83±4.98比9.12±5.35，t＝0.707，P＝0.383）；腹瀉髮生率為26.7%（8/30），腹瀉組血清肉毒堿濃度較非腹瀉組稍低（μmol/L：8.27±5.78比9.73±4.78，t＝0.607，P＝0.576）。總住院時間為（34.72±16.66）d，住院時間≥45 d者（8例）血清肉毒堿濃度較＜45 d者（22例）明顯降低（μmol/L：5.71±3.23比9.95±5.26，t＝1.627，P＝0.020）；但血清肉毒堿濃度與總住院時間無相關性（r＝-0.165，P＝0.385）。ICU住院時間為（18.60±10.72）d， ICU住院時間＞7 d者（27例）血清肉毒堿濃度較≤7 d者（3例）略有降低（μmol/L：8.44±5.00比13.24±3.65， t＝1.610，P＝0.119）；血清肉毒堿濃度與ICU住院時間無相關性（r＝-0.019，P＝0.293）。住院病死率26.67%（8/30），死亡組與存活組血清肉毒堿無差異（μmol/L：12.24±6.52比7.72±3.91，t＝-1.846，P＝0.098）；且血清肉毒堿濃度與住院病死率無相關性（r＝0.340，P＝0.066）。結論重癥患者血清肉毒堿濃度明顯下降，血清肉毒堿濃度與病情嚴重程度、血清TBil濃度相關；血清肉毒堿濃度較低的患者腸內餵養總量減少，住院時間延長。
목적：탐토중증환자혈청육독감결핍적상관인소급기대주원시간적영향。방법채용전첨성관찰성연구방법，수집2013년3월지9월중산대학부속제일의원중증의학과수치적급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분＞12분적중증환자，측정입원시혈청육독감농도화기관공능등지표，기록5 d내장내영양내수정황、총주원시간、중증감호병방（ICU）주원시간、원내병사솔，분석기대혈청육독감농도적영향급상관성。결과공입선30례중증환자，입원시혈청육독감농도하강지（8.92±5.05）μmol/L（정상삼고치43.5μmol/L）。입원시APACHEⅡ평분＞23분자（7례）혈청육독감교APACHEⅡ평분12～23분자（23례）명현강저（μmol/L：5.33±1.72비10.02±5.24，t＝2.300，P＝0.001），혈청총담홍소（TBil）＞19μmol/L자（9례）혈청육독감교TBil≤19μmol/L자（21례）명현강저（μmol/L：5.54±2.70비9.84±5.08，t＝2.750，P＝0.014）；혈청육독감농도여APACHEⅡ평분、혈청TBil정명현부상관（r＝-0.387，P＝0.035；r＝-0.346，P＝0.048）。5 d관찰기내，장내위양총량위（5134±1173）mL，혈청육독감농도여장내위양총량정명현정상관（r＝0.430， P＝0.022）。30례환자중，복창발생솔위40.0%（12/30），복창조혈청육독감농도교비복창조초저（μmol/L：7.83±4.98비9.12±5.35，t＝0.707，P＝0.383）；복사발생솔위26.7%（8/30），복사조혈청육독감농도교비복사조초저（μmol/L：8.27±5.78비9.73±4.78，t＝0.607，P＝0.576）。총주원시간위（34.72±16.66）d，주원시간≥45 d자（8례）혈청육독감농도교＜45 d자（22례）명현강저（μmol/L：5.71±3.23비9.95±5.26，t＝1.627，P＝0.020）；단혈청육독감농도여총주원시간무상관성（r＝-0.165，P＝0.385）。ICU주원시간위（18.60±10.72）d， ICU주원시간＞7 d자（27례）혈청육독감농도교≤7 d자（3례）략유강저（μmol/L：8.44±5.00비13.24±3.65， t＝1.610，P＝0.119）；혈청육독감농도여ICU주원시간무상관성（r＝-0.019，P＝0.293）。주원병사솔26.67%（8/30），사망조여존활조혈청육독감무차이（μmol/L：12.24±6.52비7.72±3.91，t＝-1.846，P＝0.098）；차혈청육독감농도여주원병사솔무상관성（r＝0.340，P＝0.066）。결론중증환자혈청육독감농도명현하강，혈청육독감농도여병정엄중정도、혈청TBil농도상관；혈청육독감농도교저적환자장내위양총량감소，주원시간연장。
Objective To investigate the related factors of serum carnitine deficiency in critical ill patients, and the influence of its deficiency on the length of hospital stay. Methods A prospective study was conducted. Critical ill patients with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score>12 admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University from March 2013 to September 2013 were enrolled. Serum carnitine concentration and indexes of organ function were determined,and the tolerance of enteral nutrition within 5 days,the length of hospital stay,the length of intensive care unit(ICU)stay,and the hospital mortality were recorded. The relationship between serum carnitine and indexes mentioned above was analyzed. Results Thirty critically ill patients were enrolled. Serum carnitine concentration was very low in all critically ill patients,i.e. (8.92±5.05)μmol/L(normal reference value at 43.5 μmol/L)at hospital admission. Serum carnitine concentration in patients with APACHEⅡscore>23(7 cases)was significantly lower than that in those with APACHEⅡscore 12-23(23 cases,μmol/L:5.33±1.72 vs. 10.02±5.24,t=2.300,P=0.001). Serum carnitine concentration in patients with serum total bilirubin(TBil)>19μmol/L(9 cases)was significantly lower than that in those with TBil≤19μmol/L(21 cases,μmol/L:5.54±2.70 vs. 9.84±5.08,t=2.750,P=0.014). Serum carnitine concentration was negatively correlated with the APACHEⅡscore and the TBil(r=-0.387,P=0.035;r=-0.346,P=0.048). During the 5-day observation period,enteral feeding amount〔(5 134±1 173)mL〕was positively correlated with serum carnitine concentration(r=0.430,P=0.022). In 30 critical patients,the incidence of abdominal distension was 40.0%(12/30),and the serum carnitine concentration of patients with abdominal distension was lower compared with that of patients without abdominal distension(μmol/L:7.83±4.98 vs. 9.12±5.35,t=0.707,P=0.383). The incidence of diarrhea was 26.7%(8/30),and the serum carnitine concentration of diarrhea patients was lower compared with that of patients without diarrhea(μmol/L:8.27±5.78 vs. 9.73±4.78,t=0.607,P=0.576). The mean length of hospital stay was(34.72±16.66)days. The serum carnitine concentrations in patients with hospital stay≥45 days (8 cases)were lower compared with those in those<45 days(22 cases,μmol/L:5.71±3.23 vs. 9.95±5.26,t=1.627,P=0.020). No correlation was found between serum carnitine concentrations and the hospital stay(r=-0.165, P=0.385). The length of ICU stay was(18.60±10.72)days. Serum carnitine concentration in patients with the length of ICU stay>7 days(27 cases)was slightly lower than that in those with the length of ICU stay≤7 days (3 cases,μmol/L:8.44±5.00 vs. 13.24±3.65,t=1.610,P=0.119). No correlation was found between serum carnitine concentrations and the length of ICU stay(r=-0.019,P= 0.293). In-hospital mortality was 26.67%(8/30). No significant difference in serum carnitine concentrations was found between the death group and the survival group(μmol/L:12.24±6.52 vs. 7.72±3.91,t=-1.846,P=0.098). No correlation was found between serum carnitine concentrations and in-hospital mortality(r=0.340,P=0.066). Conclusions Carnitine deficiency is significant in critically ill patients,and it is correlated with disease severity and serum TBil. The total amount of lenteral feeding was lower,and hospital stay was prolonged in critically ill patients with low serum carnitine level.
