Forceville X, Vitoux D, Gauzit R, Combes A, Lahilaire P, Chappuis P
Department of Medical and Surgical Intensive Care, Centre Hospitalier de Meaux, France.
Crit Care Med. 1998 Sep;26(9):1536-44. doi: 10.1097/00003246-199809000-00021.
To confirm early, marked decrease in plasma selenium concentrations in patients admitted to a surgical and medical intensive care unit (ICU), and to study this decrease according to the presence or absence of systemic inflammatory response syndrome (SIRS), sepsis, or direct ischemia-reperfusion.
Prospective, observational study.
Collaboration between the adult ICU of a 1,100-bed general hospital and a biochemical research laboratory of a university medical center.
One hundred thirty-four consecutive surgical and medical ICU patients.
None.
In the first 31 patients, plasma and urine selenium concentrations were measured by electrothermal atomic absorption spectrometry on admission and once weekly during their ICU stay. These values were compared first with severity scores, criteria for SIRS, sepsis, and organ system failure taken on admission, and then with nosocomial infection, organ system failure during ICU stay, and hospital mortality. An early, low mean plasma selenium concentration was observed in these patients compared with selenium laboratory reference values. Plasma selenium, measured on ICU admission, inversely correlated with Acute Physiology and Chronic Health Evaluation II or Simplified Acute Physiology II scores. Patients with SIRS had lower selenium concentrations than those without SIRS. Mean urine selenium losses were normal in the first 31 patients. Plasma selenium concentration was low in all patients with severe sepsis and septic shock (range 0.20 to 0.72 micromol/L) and in those patients with ischemia-reperfusion from aortic cross-clamping (range 0.34 to 0.68 micromol/L). Despite recommended specific selenium supplementation, plasma selenium concentrations remained low for >2 wks in patients with SIRS. However, there was a slight increase in plasma selenium concentrations in surviving SIRS patients, whereas plasma selenium concentrations decreased in nonsurviving patients. The frequency of ventilator-associated pneumonia, organ system failure, and mortality was three times higher in patients with low plasma selenium concentration at the time of admission (selenium < or =0.70 micromol/L) than for the other patients.
In severely ill ICU patients with SIRS, we observed an early 40% decrease in plasma selenium concentrations, reaching values observed in deleterious nutritional selenium deficiency. This prolonged decrease in selenium concentrations could explain the three-fold increase in morbidity and mortality rates in these patients compared with other ICU patients. The efficacy of selenium treatment in SIRS patients with a high gravity index score or hypoperfusion needs further investigation.
证实外科和内科重症监护病房（ICU）患者血浆硒浓度早期显著降低，并根据是否存在全身炎症反应综合征（SIRS）、脓毒症或直接缺血再灌注来研究这种降低情况。
前瞻性观察研究。
一家拥有1100张床位的综合医院的成人ICU与一所大学医学中心的生化研究实验室合作。
134例连续入住外科和内科ICU的患者。
无。
在最初的31例患者中，入院时及在ICU住院期间每周一次通过电热原子吸收光谱法测量血浆和尿液中的硒浓度。首先将这些值与入院时的严重程度评分、SIRS、脓毒症及器官系统衰竭标准进行比较，然后与医院感染、ICU住院期间的器官系统衰竭及医院死亡率进行比较。与硒实验室参考值相比，这些患者早期血浆硒平均浓度较低。ICU入院时测得的血浆硒与急性生理与慢性健康状况评分系统II（APACHE II）或简化急性生理学评分系统II（SAPS II）呈负相关。患有SIRS的患者硒浓度低于未患SIRS的患者。最初31例患者的平均尿硒流失正常。所有严重脓毒症和脓毒性休克患者（范围为0.20至0.72微摩尔/升）以及因主动脉交叉钳夹导致缺血再灌注的患者（范围为0.34至0.68微摩尔/升）血浆硒浓度均较低。尽管推荐了特定的硒补充剂，但SIRS患者血浆硒浓度在超过2周的时间内仍保持较低水平。然而，存活的SIRS患者血浆硒浓度略有升高，而非存活患者血浆硒浓度则降低。入院时血浆硒浓度低（硒≤0.70微摩尔/升）的患者发生呼吸机相关性肺炎、器官系统衰竭及死亡率的频率是其他患者的三倍。
在患有SIRS的重症ICU患者中，我们观察到血浆硒浓度早期降低40%，达到有害性营养性硒缺乏时观察到的值。硒浓度的这种持续降低可以解释与其他ICU患者相比，这些患者发病率和死亡率增加了三倍。对于高严重程度指数评分或存在低灌注的SIRS患者，硒治疗的疗效需要进一步研究。
