Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Nutrition. 2010 Jan;26(1):133-6. doi: 10.1016/j.nut.2009.06.004.
Thiamine is an essential component of cellular metabolism, and lack of this vitamin results in a potentially life-threatening biochemical lesion. The stress of surgery and critical disease depletes electrolytes, minerals, and essential biochemical substrates. We hypothesized that critical illness (represented by major surgery) would result in decreased thiamine levels over time.
We performed a prospective, observational study of serial thiamine levels of 15 patients who underwent non-emergent coronary artery bypass graft surgery. The primary endpoint was change in thiamine levels from before to immediately after surgery. Secondary endpoints included change in thiamine levels from presurgical to 6- and 24-h time points.
Of the 15 study patients, 1 did not have a plasma thiamine measurement at time 0 because of laboratory error and could not be accounted for in paired comparisons over time. Plasma thiamine levels decreased significantly from before to after coronary artery bypass grafting (P=0.0004). In addition, there was a statistically significant decrease in thiamine levels from before surgery to 24h (P=0.003).
Our data suggest that major surgery (as a surrogate for the stress of critical illness) depletes thiamine levels; further study is needed to determine whether routine replacement of thiamine in the critically ill is warranted.
硫胺素是细胞代谢的必需组成部分，这种维生素的缺乏会导致潜在的危及生命的生化损伤。手术和重症疾病的压力会消耗电解质、矿物质和必需的生化底物。我们假设重症疾病（以大手术为代表）会导致硫胺素水平随时间降低。
我们对 15 名接受非紧急冠状动脉旁路移植手术的患者进行了一项前瞻性、观察性的硫胺素水平系列研究。主要终点是手术前后硫胺素水平的变化。次要终点包括术前与 6 小时和 24 小时时间点的硫胺素水平变化。
在 15 名研究患者中，由于实验室错误，1 名患者在时间 0 时没有进行血浆硫胺素测量，因此无法进行时间点的配对比较。冠状动脉旁路移植术后，血浆硫胺素水平显著降低（P=0.0004）。此外，从术前到 24 小时，硫胺素水平呈统计学显著下降（P=0.003）。
我们的数据表明，大手术（作为重症疾病压力的替代指标）会消耗硫胺素水平；需要进一步研究以确定是否需要对重症患者常规补充硫胺素。
