酒精中毒对交通事故重型颅脑外伤患者 炎症反应和预后的影响

Role of blood alcohol concentration in inflammatory reaction and clinical outcome in traumatic patients with severe traumatic brain injury

摘要:

目的 探讨血清酒精浓度（BAC）对交通事故重型颅脑外伤患者炎症反应和预后结果的影响。方法 采用前瞻性研究选取2012 年1 月—2016 年12 月收治的92 例交通事故重型颅脑外伤患者，根据酒精浓度将 患者分为BAC 阳性组（40 例，BAC>0.5‰）和BAC 阴性组[52 例，BAC<0.5‰，将伤情严重程度评分（ISS） ≥ 16 和简略受伤标准（AIS）头部AIS ≥ 3 的患者纳入该研究]。患者入急诊科采集血标本检测BAC、白细 胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、C 反应蛋白（CRP）及白细胞计数水平，收集患者在急诊 室或院前急救时的临床资料和生存情况，根据两组不同指标进行统计学分析。结果 两组ISS 评分和格拉斯 哥评分（GCS）比较，差异无统计学意义（P >0.05）；BAC 阳性组IL-6、TNF-α、CRP 及白细胞计数低于 BAC 阴性组（P <0.05）；BAC 阳性组收缩压、心率及体温均低于BAC 阴性组，而呼吸频率高于BAC 阴性组 （P <0.05）；BAC 阳性组输浓缩红细胞较少（P <0.05）；两组住院时间比较差异无统计学意义（P >0.05）。两 组颅脑外伤的并发症包括单器官衰竭、多器官衰竭及全身炎症反应综合征（SIRS）、脓肿、肺炎和急性呼吸 窘迫综合征（ARDS）比较，差异无统计学意义（P >0.05）。结论 创伤性脑损伤（TBI）患者中BAC 阳性与 IL-6、TNF-α、CRP 及白细胞计数的下降有相关性，酒精可能对TBI 患者单核细胞等免疫细胞具有抑制炎 症因子分泌的作用。

Abstract:

Objective To investigate the influences of blood alcohol concentration (BAC) on inflammatory reactions and clinical outcomes in traumatic patients with severe traffic-related traumatic brain injuries (TBI). Method A total of 92 severe TBI patients admitted into our hospital from January 2012 to December 2016 were included in this prospective study. Patients with an Injury Severity Score (ISS) < 16 and Abbreviated Injury Scale- Head (AIS-Head) < 3 were excluded. Patients were divided into BAC positive group in which BCA > 0.5%, and BAC negative group in which BAC < 0.5% Serum levels BAC, Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and leukocyte counts were measured. Clinical data of patients were recorded. Results Forty patients were included in BAC positive group and 52 patients were included in BAC negative group. There was no significant difference in ISS and Glasgow Coma Scale (GCS) scores, and hospital stay was observed between two groups. Blood levels of IL-6, TNF-α, CRP and leukocyte counts were significantly lower in BAC positive group compared with that in BAC negative group (P < 0.05). Patients in BAC positive group exerted significant decreased levels of systolic blood pressures, heart rates, body temperatures, and packed red blood cells while increased breathing rate when compared with those in BAC negative group (P < 0.05). The two groups showed no significant differences in rates of in-hospital complications during their hospital stays including single/ multiple-organ failure, systemic inflammatory response syndrome (SIRS), sepsis, pneumonia, and acute respiratory distress syndrome (ARDS). Conclusion This study shows that existence of BAC in TBI patients is associated with immunosuppressive effects.