急性重症脑外伤患者血浆儿茶酚胺含量变化的临床意义

The plasma concentrations of catecholamines in patients with acute severe brain injury

本文用高速液相色谱-电化学检测器,测定了20例正常人及41例急性重症脑外伤患者血中儿茶酚胺(CA)含量,结合 CT 所见及临床特点进行了对比研究。结果表明:外伤组血浆 CA 含量显著高于正常组;受伤24小时内血浆 NE、E 含量与 GCS 显著相关;脑外伤急性期血浆CA 含量在不同类型外伤间存在差异;伤后24小时内血浆 NE、E 含量与 GOS 密切相关;脑外伤急性期血浆 NE 含量与应激性溃疡发病率密切相关;伤后3天血浆 NE、E 在恢复良好组内呈下降趋势,在死亡组中则呈上升趋势。

By means of high performance liquid chromato-graphy-electrochemical detection(HPLC-ECD),wedetermined the plasma levels of catecholamine in 20normal individuals and 41 patients with acute se-vere brain injury in association with the image ofCT and clinical features.The results showed that:(1)the plasma levels of catecholamine in patientswith acute severe brain injury were significantlyhigher than those in normal controls(P 0.01);(2)there was a obivious negative correlation betweenthe plasma levels of norepinephrine(NE),epinephrine(E)and Clasgow Coma Scale(GCS)within 24hours after brain injury((?)NE=0.776,(?)E=-0.82);(3)the plasma levels of NE in patients with epidu-ral hematoma or intradural hematoma and primarybrainstem injury were significantly higher and theplasma levels of dopamine were lower than thosepatients with diffuse brain injury(4)If plasma NElevels greater than 900pg ml(normal value lessthan 445.10pg ml)or plasma E levels greater than277.00pg ml(normal value less than 99.39pg ml).then the patients usually had a poor prognosis;(5)If the plasma NE levels greater than 1000pg mlusually indicated a stress gastric ulcer might occur;(6)3 days after injury,in good recovery group theplasma levels of NE and E decreased significantly.while in death group the plasma levels of NE and Eincreased signficantly.