严重创伤后血脂降低提示晚期呼吸机相关性肺炎、呼吸机依赖和死亡的风险：一项连续患者的回顾性研究。

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients.

机构信息

Trauma/Critical Services, St. Elizabeth Health Center, 1044 Belmont Avenue, Youngstown, OH 44501, USA.

出版信息

Lipids Health Dis. 2011 Mar 3;10:42. doi: 10.1186/1476-511X-10-42.

DOI:10.1186/1476-511X-10-42

PMID:21371328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3058028/

Abstract

BACKGROUND

Post-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and other potential risk factors for the development of VAP.

METHODS

We performed a retrospective study of consecutive trauma patients requiring emergency tracheal intubation and evaluated TC, age, gender, ethanol status, smoker status, injury mechanism, chest injury, brain injury, Injury Severity Score (ISS), shock, day-one hypoxemia, and RBC transfusion as potential risks for VAP.

RESULTS

The 152 patients had ISS 28.1, brain injury 68.4%, VAP 50.0%, ventilator days 14.3, and death 9.9%. Ventilator days were increased with late VAP (p < 0.0001). TC was 110.7 mg/dL with expected TC 197.5 mg/dL. TC was lower with chest injury, shock, and RBC transfusion but, higher with brain injury (p ≤ 0.01). TC decreased as ISS increased (p = 0.01). However, one patient subset (ISS ≥ 20-&-TC ≥ 90 mg/dL) had a relative increase in TC despite an increase in ISS. ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only independent predictor of late VAP (OR 3.0; p = 0.002). ISS ≥ 20-&-TC ≥ 90 mg/dL and day-one hypoxemia were the only independent predictors for increased ventilator days (p = 0.01). ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only predictor of death (OR 3.8; p = 0.03).

CONCLUSIONS

Severe traumatic injury produced substantial hypocholesterolemia that is greater with chest injury, shock, and RBC transfusion, but less with brain injury. Total blood cholesterol tended to decrease with increasing injury severity. However, attenuated hypocholesterolemia (ISS ≥ 20-&-TC ≥ 90 mg/dL) represents a unique response that can occur with critical injury. Attenuated hypocholesterolemia signals early risk for late VAP, ventilator dependency, and death.

摘要

背景

创伤后呼吸机相关性肺炎（VAP）是一个重大的临床问题，它会增加医院成本，通常会延长机械通气时间。我们评估了 VAP 对通气时间的影响。我们还评估了 48 小时总胆固醇（TC）和其他可能导致 VAP 发展的潜在危险因素。

方法

我们对需要紧急气管插管的连续创伤患者进行了回顾性研究，并评估了 TC、年龄、性别、乙醇状态、吸烟状态、损伤机制、胸部损伤、脑损伤、损伤严重程度评分（ISS）、休克、第一天低氧血症和 RBC 输血作为 VAP 的潜在危险因素。

结果

152 例患者的 ISS 为 28.1，脑损伤 68.4%，VAP 50.0%，通气时间 14.3 天，死亡率 9.9%。晚期 VAP 会增加通气时间（p<0.0001）。TC 为 110.7mg/dL，预期 TC 为 197.5mg/dL。与胸部损伤、休克和 RBC 输血相比，TC 较低，但与脑损伤相比，TC 较高（p≤0.01）。随着 ISS 的增加，TC 减少（p=0.01）。然而，尽管 ISS 增加，但有一组患者（ISS≥20-和 TC≥90mg/dL）的 TC 相对增加。ISS≥20-和 TC≥90mg/dL，而不是单独的 ISS，是晚期 VAP 的唯一独立预测因子（OR 3.0；p=0.002）。ISS≥20-和 TC≥90mg/dL 以及第一天低氧血症是通气时间增加的唯一独立预测因子（p=0.01）。ISS≥20-和 TC≥90mg/dL，而不是单独的 ISS，是死亡的唯一预测因子（OR 3.8；p=0.03）。

结论

严重创伤导致显著的低胆固醇血症，与胸部损伤、休克和 RBC 输血相关，与脑损伤相关则较低。总胆固醇随着损伤严重程度的增加而趋于降低。然而，减弱的低胆固醇血症（ISS≥20-和 TC≥90mg/dL）代表一种独特的反应，可能发生在严重损伤时。减弱的低胆固醇血症提示晚期 VAP、呼吸机依赖和死亡的早期风险。