顱腦創(chuàng)傷后胃腸道出血與應(yīng)激激素變化關(guān)系的研究.pdf

1、Objective: Our study makes the evaluation of the local risk factors of TBI patients developing the gastrointestinal bleeding during seven days of hospitalization in Neurosurgery intensive care unit. We measured the ser

2、um adrenocorticotropin hormone (ACTH),Cortisol (Cort) and serum Gastrin to observe their variations compare to a volunteers healthy group and, we analyzed the existing risk factors and the possible intrinsic aggravating

3、factors leading to gastrointestinal bleeding. That may help us prevent the severe neurotraumatologic complications like gastrointestinal bleeding, and to elaborate a better Neurotrauma emergency guideline. Method:In

4、this study, we join the neurotraumatology intensive care unit from July to December 2005 to collect the 42 TBI patients admitted in our study, with the 13without any psychological or mechanical stress healthy volunteers

5、called normal control.Three blood samples were obtained from each patient via an existing arterial line, at 8:00 in the morning the first day (within 24H, 2-3D, 5-7D) to measure the plasmatic ACTH, cortisol, and gastrin

6、concentration. After the collection, the serum was immersed in an ice bath following collection. Thereafter remove the serum by centrifugation and stored at -80℃ immediately in plastic glass tubes. Then with the Immulite

7、 1000 systems Analyzer we test the quantitative measurement of ACTH, cortisol and gastrin. The data were analyzed with SPSS11.5 a two-tailed P value based on the 95％ confidence interval was considered significant. ACTH,

8、Cortisol, gastrin, were compared between the healthy group and the experimental group, in the experimental group, we compare their variation between the gastrointestinal bleeding and the no bleeding patients. Result:

9、 Within 24h following the TBI, Cortisol, ACTH, Gastrin concentration showed a significant increase in the experimental group (P＜0.05). The concentrations of every hormone were higher in the gastrointestinal group than th

10、e no bleeding group (P＜0.01). The clinical significance gastrointestinal bleeding appears in 23.80％(10/42) of experimental patients.Following TBI, Cortisol, ACTH, Gastrin concentration showed a significant increase propo

11、rtionally to the severity of injury and The Spearman Rank test showed significant positive correlations respectively between GCS and serum ACTH (within 24h) (r= 0.43, P ＜0.05), between gastrointestinal bleeding apparitio

12、n and serum Gastrin (within 24h)(r=0.312 P＜0.05). Significant negatives correlations appeared between gastrointestinal bleeding and hemoglobinemia (r = -0.420 with P ＜0.01),between MCTC on admission and serum Cortisol (w

13、ithin 24h) (r = -0.347, P＜0.05).Unifactorial logistic regression analysis presented GCS, HCT and Hb as the main risk factors for gastrointestinal bleeding (P = 0.009, ＜ 0.014, ＜ 0.029, ＜ 0.05.). The gradual factors logis

14、tic regression showed a strong correlation for Gastrin concentration (within24h) (OR = 26.643 P＜ 0.05) anda moderate correlation Hematocrite with for (OR = 5.385 P＜ 0.05) with gastrointestinal apparition. High ACTH conce

15、ntration within 24h (＞ 100pg/ml) tends to increase the frequency of gastrointestinal bleeding. Cortisol, ACTH, Gastrin concentrations highly decreased within first 3 days and did not show any significant change later.

16、In the severe TBI group, the gastrointestinal bleeding presented in 40.91％(9/22) with routine antacids treatment. And the mortality was 20 ％ (2/10) in the gastrointestinal bleeding group. Conclusions:1. The moderate

17、 or severe traumatic brain injury often led to traumatic brain syndrome with general disturbances in Neuroendocrinology. After trauma the hypothalamic-pituitary-adrenal (HPA) axis get high stimuli to release high conc

18、entration of ACTH and Cortisol, simultaneously the Gastrin increased significantly. In high Gastrin group, there is a high incidence of gastrointestinal bleeding. 2. The risk factors of post traumatic gastrointestin

19、al bleeding are low GCS, high ACTH (100pg/ml), high gastrin and low Hemoglobin. The factors can be the predictive values for gastrointestinal bleeding. 3. The severe TBI patients have a high risk of gastrointestinal