重症患者血清肉毒碱缺乏相关因素及其对住院时间的影响  

Related factor of serum carnitine deficiency and influence of its deficiency on the length of hospital stay in critical ill patients

作　　者：周昭雄[1] 邱春芳[2] 陈传希[2] 王陆豪 陈娟[2] 陈敏英[2] 管向东[2] 欧阳彬[2] 

机构地区：[1]广州医科大学附属第四医院重症医学科 [2]中山大学附属第一医院重症医学科,广东广州510080

出　　处：《中华危重病急救医学》2014年第12期890-894,共5页Chinese Critical Care Medicine

基　　金：基金项目：广东省科技计划项目（20108031600314）;国家临床重点专科建设项目（2011-872）

摘　　要：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）�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

关 键 词：血清肉毒碱 重症 病情严重程度 总胆红素 住院时间 

分 类 号：R459.7[医药卫生—急诊医学]