微量元素补充对术后脓毒症病人炎症反应的影响

目的: 评估外科术后脓毒症病人体内微量元素含量对炎症反应的影响。方法: 纳入2013年8月至2014年7月本院外科重症监护室收治的术后脓毒症,72 h内肠内营养未达84 J（20 kal）/（kg·d）、需应用静脉营养的病人。利用原子吸光度法监测第1天及第10天血铜、锌、铁含量。仅应用静脉营养支持的40例病人行微量元素补充的前瞻性随机对照研究。微量元素补充组20例多种微量元素合剂10 mL加入静脉营养中,每天滴注,持续10 d。行微量元素含量与临床指标和感染指标的相关分析。结果: 184例病人符合入选标准97例。脓毒症第1天血铁缺乏达62.89%,血锌缺乏达16.49%,与病人APACHE Ⅱ评分负相关,相关系数分别为-0.284和-0.297。血铁含量还与感染好转时间及抗生素使用时间负相关,相关系数分别为-0.313和-0.217。前瞻性随机对照研究显示,微量元素补充组的血铜、锌和铁含量有升高趋势,降钙素原及C反应蛋白下降明显。与对照组比较,补充组C反应蛋白下降明显（P=0.006）,较少发展至脓毒症休克（25%比65%,P=0.011）。结论: 外科术后脓毒症病人的血锌及血铁含量明显降低,与病情严重程度及感染控制疗效相关。

Impact of trace element supplementation on inflammatory response in postoperative patients with sepsis

Objective To evaluate the impact of trace element in postoperative patients with sepsis on inflammatory response. Methods The postoperative patients with sepsis from August 2013 to July 2014 at intensive care unit in our hospital who need intravenous nutrition because of enteral nutrition in 72 hours less than 84 J(20 kal)/(kg·d) were inclu-ded. Concentrations of copper, zinc and iron in serum were detected with atomic absorption spectrophotometry on first day and tenth day. Relation of trace element concentrations to clinical and infection parameters was analyzed. A prospective randomized and controlled study was performed including 40 cases with only intravenous nutrition. Twenty cases were given 10 days of multiple-trace element intravenously 10 mL per day as group of multiple-trace element supplementation (MTES). Results There were 97 in 184 cases with sepsis who coincided with incision criteria enrolled in this study. At first day diagnosed as sepsis 62.89% of cases had iron deficient and 16.49% had zinc deficient. The concentrations of iron and zinc in serum related to APACHE Ⅱ scores negatively with correlation coefficient -0.284 and -0.297, respectively. Concentration of iron in serum related to the better sign time of treatment of infection and the duration of antibiotic treatment negatively (correlation coefficients -0.313 and -0.217, respectively). It was shown in prospective randomized and controlled study that procalcitatonin and C-reactive protein reduced significantly and concentration of serum copper, zinc and iron had trends of increase in MTES group. Concentration of C-reactive protein reduced significantly in MTES group when compared to control group (P=0.006) and fewer cases developed septic shock (25% vs 65%, P=0.011). Conclusions Lower concentrations of zinc and iron in serum were present in postoperative patients with sepsis which related to extent of severity and to the results in treatment of infection.