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颅脑创伤后的胃肠道出血与应激激素变化关系的研究

作　者: BITEGHE-BI-NZENG Alain-Pascal（阿兰-比得戈）
导　师: 张建宁
学　校: 天津医科大学
专　业: 外科学
关键词: Traumatic brain injury ACTH Cortisol Gastrin gastrointestinal bleeding
分类号: R651.15
类　型: 硕士论文
年　份: 2006年
下　载: 42次
引　用: 0次
阅　读: 论文下载

内容摘要

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 serum 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 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.MethodIn 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 13 without any psychological or mechanical stress healthy volunteers 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 concentration. After the collection, the serum was immersed in an ice bath following collection. Thereafter remove the serum by centrifugation and stored at -80°C immediately in plastic glass tubes. Then with theImmulite 1000 systems Analyzer we test the quantitative measurement of ACTH, cortisol and gastrin. The data were analyzed with SPSS 11.5 a two-tailed P value based on the 95% confidence interval was considered significant. ACTH, 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: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 the 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 proportionally 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 apparition 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 (within 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 logistic regression showed a strong correlation for Gastrin concentration (within24h) (OR = 26.643 P< 0.05) and a moderate correlation Hematocrite with for (OR = 5.385 P< 0.05) with gastrointestinal apparition.High ACTH concentration within 24h (>100pg/ml) tends to increase the frequency ofgastrointestinal bleeding. Cortisol, ACTH, Gastrin concentrations highly decreased within first 3 days and did not show any significant change later.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 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 concentration 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 gastrointestinal bleeding are low GCS, high ACTH (lOOpg/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 bleeding. The TBI patients with gastrointestinal bleeding are with high mortality.

全文目录

Abstract  5-8
Introduction  8-12
Materials and Methods  12-25
Results  25-30
STATISTICAL ANALYSIS  30-46
Discussion  46-50
Conclusion  50-51
References  51-56
ACKNOWLEDGEMENTS  56-57

颅脑创伤后的胃肠道出血与应激激素变化关系的研究

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