创伤后细胞损伤的监测与评价  

Monitoring and evaluating on cell injury in patients with severe trauma

作　　者：田利华[1] 胡耑[1] 白祥军[1] 周锡渊[1] 赵鸿[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030

出　　处：《中华急诊医学杂志》2008年第6期627-630,共4页Chinese Journal of Emergency Medicine

基　　金：湖北省科技攻关基金资助项目（2005AA301C31）

摘　　要：目的观测创伤后血清细胞因子、氧自由基及酸性产物的含量变化，探讨其细胞代谢的监控效应及评价细胞损伤的方法。方法选取本院2005年5月至2007年2月间经规范程序救治，临床资料完整的创伤患者117例，采用损伤严重度评分（ISS）和急性生理学及慢性健康状况评分（APACHEⅡ）对其组织损伤程度和伤后病情危害状况进行层次分组，依据病情变化实时检测各组的动脉血乳酸（ABL）、动脉血碱缺失（BD）、超氧化物歧化酶（SOD）、脂质过氧化物（LPO）、肿瘤坏死因子（TNF-α）和白细胞介素-6（IL-6）的血清水平，数据以（-↑x±s）表示，多组资料采用方差分析后两两比较，以P〈0．05为差异具有统计学意义。结果本组监测指标伤后就可出现明显变化，随损伤严重程度或病情危害状况的加重而显示组间差异具有统计学意义（P〈0．05）。若并发缺血缺氧或休克、全身炎症反应综合征（SIRS）或感染以及多器官功能障碍综合征（MODS）时其异常增向则更为显著差异具有统计学意义（P〈0．01）。患者发生病情恶化或器官衰竭危机时，各指标水平常呈现持续异常或紊乱状态，与未发生者比较差异具有统计学意义（P〈0．01）。结论细胞损伤反应与损伤严重程度、病情演变、MODS危机及患者预后有关，其血清指标的异常变化多预示着病情危危，实时检测有助于提高临床监控水平。Objective To observe the changes in cytokines, oxygen free radicals, acidulous production in serum and to investigate the effectiveness of monitoring metabolism of cells and the method for evaluating cell injury in patients with severe trauma. Method The detailed data of 117 patients rescued and managed carefully from May 2005 to February 2007 were assessed and stratified with ISS and APACHE Ⅱ , and the serum levels of arterial blood lactate（ABL）, base deficit（BD）, superoxide（ SOD）, lipid peroxide（LPO）, TNF-α and IL-6 were measured in real-time according to the condition of the patient. Results The monitoring biomarkers obviously changed with injury severity which endangered the situation of patients after trauma （ P 〈 0.05）, especially in the patients with ischemia, hypoxia, shock, infection, SIRS, and MODS （ P 〈 0.01 ）. The persistence of extremely elevated levels of biomarkers meant the organ failure and fatality of patients after trauma, and there was a obvious differece between those cases and cases without elevation of biomarkers （ P 〈 0.01 ）. Conclusions The outcome of patients after trauma is closely correlated with injury severity, infection and MODS, and the levels of biomarkers including ABL, SOD, LPO,TNF-α and IL-6 are useful indicators of outcome measure.

关 键 词：创伤与损伤 细胞损伤 多器官功能障碍综合征 创伤评分 

分 类 号：R641[医药卫生—外科学]