血清瓜氨酸评估严重创伤后早期急性胃肠损伤的临床价值

doi:10.3969/j.issn.1002-1949.2017.11.012

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摘要目的：通过测定严重创伤后患者早期不同时间点的血清瓜氨酸水平，探讨其在预测严重创伤后患者急性胃肠损伤及器官衰竭中的临床意义。方法：采用前瞻性研究方法，纳入2015-08~2016-12入住兰州大学第二医院MICU严重创伤患者72例，根据创伤严重度评分(injury severity score, ISS)分为轻度创伤组(ISS＜16分)32例，简称轻伤组，重度创伤组(ISS≥16分)40例，简称重伤组。再根据2012年欧洲危重病医学会(ESICM)急性胃肠损伤(acute gastrointestinal injury, AGI)分级指南将患者分为四个亚组，即AGI 0组26例、AGI 1组16例、AGI 2组20例和AGI 3组10例。选择同期兰州大学第二医院健康体检者20例作为正常对照组。收集患者临床基本资料、AGI分级，采集入院第1、3天静脉血标本，应用高效液相法测量血清瓜氨酸水平。结果：重伤组、轻伤组血清瓜氨酸水平较对照组明显降低(P＜0.01或P＜0.05)，且重伤组低于轻伤组(P＜0.01)，第3天各亚组血清瓜氨酸水平较第1天均进一步下降(P均＜0.01)。AGI各亚组中血清瓜氨酸水平随着分级越高，其水平下降越显著(P＜0.01或P＜0.05)，第3天各组血清瓜氨酸水平较第1天均进一步下降(P均＜0.01)。血清瓜氨酸水平与AGI严重程度、SOFA评分、APACHEⅡ评分呈负相关。血清瓜氨酸≤19.07 μmol/L是预测严重创伤后AGI的最佳界值。结论：严重创伤后早期血清瓜氨酸水平明显降低且与创伤严重程度呈负相关，对预测创伤后早期AGI、MODS发生、发展的病理过程具有一定临床价值。

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	王锐
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收稿日期: 2017-03-05

通讯作者: 李培杰(1962-)，男，科主任，主任医师，硕士研究生导师,E-mail:lipeijielanzhou@hotmail.com。

作者简介: 王锐(1987-)，男，硕士，住院医师，E-mail:727111682@qq.com。

引用本文:

王锐，李培杰，尹路路，苏成洋，张致苍. 血清瓜氨酸评估严重创伤后早期急性胃肠损伤的临床价值[J]. 中国急救医学, 2017, 37(11): 1020-1024.
Wang Rui, Li Pei-jie, Yin Lu-lu, Su Cheng-yang, Zhang Zhi-cang. The value of serum citrulline in predicting the early acute gastrointestinal injury after severe trauma. Chinese Journal of Critical Care Medicine, 2017, 37(11): 1020-1024.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.11.012 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I11/1020

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