重型颅脑损伤患者脑水肿指数与应激性消化道出血及血清一氧化氮、脂质过氧化物水平的关系

Association of index of cerebral edema with gastrointestinal bleeding and serum levels of NO and LPO in patients with severe traumatic brain injury

目的探讨重型颅脑损伤患者脑水肿指数与应激性消化道出血及血清一氧化氮(NO)和脂质过氧化物(LPO)水平的关系。方法自2009年6月至2011年6月保守治疗658例重型颅脑损伤患者,均于入院第2、5天应用无创脑水肿动态监护仪监测脑水肿指数。入院第2、5天清晨空腹抽静脉血检测血清NO、LPO水平。结果658例重型颅脑损伤患者中,发生消化道出血80例,发生率为12.2%。入院第2、5天脑水肿指数越高,消化道出血发生率越高(P<0.05)、发生首次出血时间越短(P<0.05)、出血持续时间越长(P<0.05)、出血量越大(P<0.05)。不同脑水肿指数患者入院第2天血清NO、LPO水平无显著变化(P>0.05),入院第5天脑水肿指数越高,血清NO、LPO水平越高(P>0.05)。结论重型颅脑损伤患者脑水肿指数与应激性消化道出血、血清NO和LPO水平密切相关,而且直接影响消化道出血患者出血时间、出血量。

ObjectiveTo explore the relationship between the index of cerebral edema and the gastrointestinal bleeding and the serum levels of nitric oxide（NO） and lipoperoxide（LPO） in patients with severe traumatic brain injury（sTBI）.MethodsSix hundred and fifty-eight patients with sTBI were prospectively recruited in this study. All patients received conservative treatment. The index of cerebral edema was detected by the noninvasive brain edema dynamic monitoring（twice a day, 20~30 minutes for one time） on the second and fifth day following admission. The serum level of NO was detected by colorimetric assay method and the serum level of LPO was detected by enzyme-linked immunosorbent assay.ResultsOf 658 patients with sTBI, gastrointestinal bleeding occurred in 80 patients. The incidence was 12.2%. The incidence, the volume and the duration of gastrointestinal bleeding significantly increased when the index of cerebral edema increased on the second and fifth day following admission（P〈0.05）. The serum levels of NO and LPO did not significantly changed on the second day following admission（P〈0.05）, but they significantly increased when the index of cerebral edema increased on fifth day（P〈0.05）.ConclusionThe index of cerebral edema is closely related to the gastrointestinal bleeding, the serum levels of NO and LPO in patients with sTBI.