重型颅脑损伤患者血浆肾上腺髓质素变化及临床意义

Changes and clinical significance of the plasma levels of adrenomedullin in the patients with serious brain injury

目的 探讨血管活性物质肾上腺髓质素 (ADM)、内皮素 - 1 (ET - 1 )、去甲肾上腺素 (NE)在重型颅脑损伤中的变化及对血流动力学的影响 ,并探讨其可能的作用机制。方法 检测 1 2例重度颅脑损伤患者血浆ADM、ET - 1、NE手术前后浓度变化。结果 重度颅脑损伤组手术前血浆ADM、ET - 1、NE浓度分别为 (65 63± 6 55)mmol/L ,(2 2 1 91± 31 42 )mmol/L ,(2 37±0 1 6)ng/mL ,明显高于正常对照组 (2 1 56± 4 2 1 )mmol/L ,(77 56± 4 2 1 )mmol/L ,(0 48± 0 0 7)ng/mL(P <0 0 1 ) ;死亡组血浆ADM、ET - 1、NE浓度分别为 (1 0 4 59± 31 33)mmol/L ,(2 71 34± 38 72 )mmol/L ,(2 88± 0 53)ng/mL ,明显高于存活组 (57 736±2 7 63)mmol/L ,(1 84 74± 31 42 )mmol/L ,(2 1 1± 0 466)ng/mL(P <0 0 5)。重度颅脑外伤患者早期存在明显的高血流动力学状态 ,术后 3～ 5d逐渐恢复。结论 ADM、ET - 1、NE参与重型颅脑损伤的病理过程 。

Objective To investigate the role of adrenomedullin(ADM),endothelin-1(ET-1),norepinephrine(NE)in the pathogenesis of serious brain injury.Methods Plasma levels of ADM,ET-1 and NE in both pre- and post- operation were measured in 12 patients with serious brain injury in.Results Pre-operation plasma levels of ADM,ET-1 and NE were significantly higher in serious brain injury group than in control group〔(65 63±6 55) mmol/L,(221 91±31 42) mmol/L,(2 37±0 16) ng/mL vs.(21 56±4 21) mmol/L,(77 56±4 21) mmol/L,(0 48±0 07) ng/mL respectively ( P <0 01)〕.It also revealed that the plasma levels of ADM,ET-1 and NE of death group were higher than those of survival group〔(104 59±31 33) mmol/L,(271 34±38 72) mmol/L,(2 88±0 53) ng/mL vs.(57 736±27 63) mmol/L,(184 74±31 42) mmol/L,(2 11±0 466) ng/mL respectively( P <0 01)〕.High hemodynamics state was found in the early stage of serious brain injury patients,and it came to normal gradually in 3～5 days.Conclusion The results indicated that ADM?ET-1?NE played an important role in the pathophysiologic process and had an effect on the hemodynamics of the patients with serious brain injury