Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Am J Med Sci. 2018 Oct;356(4):382-390. doi: 10.1016/j.amjms.2018.06.015. Epub 2018 Jun 21.
Thiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function and treat delirium.
硫胺素是参与能量（ATP）产生和必需细胞分子合成的 4 种酶的必需辅助因子。人体的硫胺素总储存量相对较小，患者可能因营养不足、酒精使用障碍、尿排泄增加和急性代谢应激而出现硫胺素缺乏。败血症患者经常硫胺素缺乏，接受手术的患者可能会出现硫胺素缺乏。这种缺乏会导致充血性心力衰竭、周围神经病、Wernicke 脑病、柯萨可夫综合征和胃肠道脚气病。此外，硫胺素缺乏可导致重症监护病房并发症的发展，如心力衰竭、谵妄、重症监护神经病、胃肠功能障碍和不明原因的乳酸性酸中毒。因此，临床医生需要考虑入住重症监护病房的患者存在硫胺素缺乏的情况，以及在治疗重症患者期间硫胺素缺乏的发展情况。静脉内给予硫胺素可以纠正乳酸性酸中毒、改善心功能和治疗谵妄。
