Hadfield J M, Little R A
North Western Injury Research Centre, Manchester, UK.
Injury. 1992;23(3):183-6. doi: 10.1016/s0020-1383(05)80041-5.
The 'flow' phase response to head injury is characterized by hypermetabolism and catabolism of lean body mass. In order to measure the contribution of protein oxidation (CPO) to resting metabolic expenditure (RME), 11 severely head injured patients (AIS 5) were studied. All patients had 24 h urine collections for at least 10 days after injury and RME was determined at intervals by indirect calorimetry. No patient received exogenous steroids. Peak urinary nitrogen excretion was 11.63 +/- 1.28 g/m2/day occurring between days 6 and 9 after injury. Fat oxidation was the greatest component of the RME at all times after head injury and the CPO to RME was 26.4 +/- 2.9 per cent during days 1-2, 31.8 +/- 3.3 per cent during days 3-5, 28.6 +/- 3.4 per cent during days 6-9 and 23.3 +/- 3.8 per cent during days 10-20 after injury. These figures are higher than those previously reported for burns, musculoskeletal injury or sepsis. The mechanism for the increased CPO is unclear. It may be related to such conditions of management as paralysis and fasting, but more likely it is an idiosyncratic feature of the metabolic response to head injury.
头部损伤的“流动”期反应的特征是代谢亢进和瘦体重分解代谢。为了测定蛋白质氧化（CPO）对静息代谢消耗（RME）的贡献，对11例重度头部损伤患者（简明损伤定级标准[AIS]为5级）进行了研究。所有患者在受伤后至少10天内进行了24小时尿液收集，并通过间接测热法定期测定RME。没有患者接受外源性类固醇治疗。尿氮排泄峰值为11.63±1.28 g/m²/天，出现在受伤后第6至9天之间。头部损伤后的所有时间里，脂肪氧化都是RME的最大组成部分，受伤后第1至2天CPO占RME的比例为26.4±2.9%，第3至5天为31.8±3.3%，第6至9天为28.6±3.4%，第10至20天为23.3±3.8%。这些数字高于先前报道的烧伤、肌肉骨骼损伤或脓毒症的相关数字。CPO增加的机制尚不清楚。它可能与诸如瘫痪和禁食等治疗情况有关，但更可能是头部损伤代谢反应的一种特质性特征。
