颅脑损伤患儿血浆内毒素变化及其临床意义分析

Changes of plasma endotoxin in children with craniocerebral injury and its clinical significance

目的研究颅脑损伤患儿血浆内毒素水平的变化及其临床意义。方法以2017年10月1日至2018年12月31日中国医科大学附属盛京医院儿科重症监护室(PICU)住院的颅脑损伤患儿29例为病例组,分别于颅脑损伤后1 d、3 d和5 d采集外周血;以10例健康体检儿童为对照组。采用内毒素鳌定实验动态检测血浆内毒素水平,比较其颅脑损伤后1 d、3 d和5 d的内毒素水平变化情况;同时收集患儿发热情况、住院时间、喂养方式、手术史、机械通气等资料,评估影响血浆内毒素水平的临床因素。结果颅脑损伤后1 d、3 d及5 d的病例组内毒素水平均明显高于对照组(P<0.05),且损伤后3 d及5 d的内毒素水平高于1 d(P<0.05)。昏迷评分(GCS)与内毒素水平呈负相关(P<0.05)。重型颅脑损伤组内毒素水平高于轻型及中型组。多器官功能障碍综合征(MODS)组内毒素水平高于非MODS组。胃肠功能障碍组内毒素水平高于非胃肠功能障碍组。入院时肠内喂养、GCS是内毒素血症的独立影响因素(P<0.05),小儿危重症评分(PCIS)与内毒素血症呈负相关,但不是其独立影响因素。结论颅脑损伤患儿损伤后3 d内毒素水平明显升高,颅脑损伤越重,内毒素水平越高;胃肠功能障碍及MODS患儿血浆内毒素水平明显升高;入院时予肠内喂养可降低内毒素水平,GCS及PCIS越低,内毒素水平越高。

Objective To study the changes of plasma endotoxin levels in children with craniocerebral injury and its clinical significance.Methods Twenty-nine children with craniocerebral injury who were hospitalized in PICU in Shengjing Hospital affiliated to China Medical University were enrolled as the case group.Peripheral blood was collected at 1 d,3 d and 5 d after craniocerebral injury,and 10 healthy children were selected as control group.Toxin determination was used to dynamically detect plasma endotoxin levels,and the changes of endotoxin levels at 1 d,3 d and 5 d after craniocerebral injury were compared.At the same time,the data on children’s fever,hospitalization time,feeding mode,surgical history and mechanical ventilation were collected to evaluate the clinical factors affecting plasma endotoxin levels.Results Endotoxin levels on day 1,day 3 and day 5 after craniocerebral injury were significantly higher than those in the control group(P<0.05),and endotoxin levels on day 3 and day 5 were higher than that on day 1(P<0.05).GCS score was negatively correlated with endotoxin levels(P<0.05).The level of endotoxin in the severe head injury group was higher than that in the light and moderate group.The level of endo toxin in the MODS group was higher than that in the non-MODS group.The endotoxin level in the gastrointestinal dysfunction group was higher than that in the non-gastrointestinal dysfunction group.Intestinal feeding and GCS score on admission were independent factors of endotoxemia(P<0.05).PCIS score was negatively correlated with endotoxemia,but it was not an independent factor.Conclusion Endotoxin levels increase significantly within 3 days after craniocerebral injury.The more severe the craniocerebral injury,the higher the endotoxin level;the plasma endotoxin level in children with gastrointestinal dysfunction and MODS increases significantly;enteral feeding on admission can reduce endotoxin levels.The lower the GCS score and PCIS score,the higher the endotoxin level.