Choi Daniel Horim, Basu Sonali, Levine Mark, Steinhorn David
Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, United Sates.
Molecular and Clinical Nutrition Section, Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States.
J Pediatr Intensive Care. 2022 Jan 21;13(2):119-126. doi: 10.1055/s-0041-1741401. eCollection 2024 Jun.
Ascorbic acid, or vitamin C, is a physiological antioxidant that has been found to be deficient in critically ill adults with sepsis and acute respiratory distress system. In adults, ascorbic acid supplementation has been shown to reduce the need for vasopressors and mechanical ventilation. This study aimed to describe the prevalence of ascorbic acid deficiency in critically ill pediatric patients. This prospective, single-centered study analyzed 34 patients aged 1 month to 18 years old with septic shock and/or acute respiratory failure requiring mechanical ventilation in a quaternary, urban, pediatric intensive care unit. Plasma ascorbic acid levels were measured by high-performance liquid chromatography within 24 hours of meeting eligibility criteria. The median level was 23.34 µM (IQR [11.45, 39.14]). Twenty-three patients had repeat samples that were collected 3 to 5 days later. The median for repeat samples was higher at 42.41 µM (IQR [13.08, 62.43]). Patients who were enterally fed had significantly higher levels than those who were not (62.4 ± 7.7 µM vs. 32.4 ± 7.1 µM; = 0.03). Ascorbic acid levels vary widely among critically ill children with septic shock and/or respiratory failure requiring mechanical ventilation, but one-half of our patients had deficient levels that are typically seen in scurvy. Further studies are warranted to investigate the significance of low levels as well as the impact of normalizing levels through nutritional support.
抗坏血酸，即维生素C，是一种生理抗氧化剂，已发现脓毒症和急性呼吸窘迫综合征的重症成年患者体内缺乏这种物质。在成年人中，补充抗坏血酸已被证明可减少对血管加压药和机械通气的需求。本研究旨在描述重症儿科患者中抗坏血酸缺乏的患病率。这项前瞻性、单中心研究分析了一家城市四级儿科重症监护病房中34例年龄在1个月至18岁之间、患有感染性休克和/或急性呼吸衰竭且需要机械通气的患者。在符合纳入标准的24小时内，通过高效液相色谱法测量血浆抗坏血酸水平。中位数水平为23.34 μM（四分位间距[IQR][11.45, 39.14]）。23例患者在3至5天后采集了重复样本。重复样本的中位数较高，为42.41 μM（IQR[13.08, 62.43]）。接受肠内喂养的患者水平显著高于未接受肠内喂养的患者（62.4±7.7 μM对32.4±7.1 μM；P = 0.03）。在患有感染性休克和/或呼吸衰竭且需要机械通气的重症儿童中，抗坏血酸水平差异很大，但我们有一半的患者水平不足，这在坏血病中较为常见。有必要进一步研究低水平的意义以及通过营养支持使水平正常化的影响。
