Mechanism And Therapy Of Vitamin Deficiency In Trauma And Sepsis Patients

Yang Bao, Student for doctorateJieshou Li, Director, Professor of Surgery;Jinling Hospital, Nanjing,210002.Vitamins deficiency has been found in trauma or septic shock patients in past years. Athough vitamins deficiency could do a lot of harm to people, the mechanism of vitamins deficiency was still not clear. The aim of this study was to investigate the mechamism of vitamins deficiency after trauma and sepsis and research the effective therapeutics for clinical practice.Part I Vitamins Metabolism and its Clinical Implication inTrauma and Sepsis PatientsExperimentl-l: Related Factors and Clinical Implication of Vitamins Metabolism in Trauma and Sepsis PatientsObjectives: The aim of this study was to determine the related factors of vitamins metabolism after trauma and sepsis. Methods: The control group consisted of 20 healthy volunteers and 20 trauma or sepsis patients were selected into trauma-sepsis group. Body weight, body temperature, hct, WBC account, APACHEII score was registered and Plasma of vitamins were measured, and the relationship of them was assessed with linear regression. Results: In these patients, plasma vitamin A(VA),vitamin E(VE) and vitamin C(VC) were significantly lower than healthy volunteers, and plasma VA,VE,VC were correlated with APACHEII score obviously. Conclusions: There was VA,VE and VC deficiency in trauma and sepsis patients, and thevitamins deficiency was correlated with the severity of illness.Experimentl-2: Change of Vitamins metabolism after traumaObjectives: To examine the change of vitamins after surgery operation in patients. Methods: We measured plasma concentration of vitamins at 0,1,3,5,day after operation in 20 patients. Results: The plasma VA,VE and VC were significantly decreased at 5 day after sugery operation. Conclusions: Trauma or sepsis could lead up to vitamins deficiency.Part II Mechanism of Vitamin deficiency in Trauma andSepsis PatientsExperiment2-l: The Influence of Experimental Sepsis on VitaminMetabolismObjectives: To determine the influence of experimental sepsis on vitamin metabolism. Methods: Using the model of cecal ligation and puncture(CLP) of SD rats, we measured plasma VA, VE, VC, malondialdehyde(MDA), glutathione(GSH), IL-1, IL-6, TNF-a at 0,1,3,5 day after CLP, and analysed the relation of them with linear regression. Results: Plasma VA, VE, VC and GSH were decreased and MDA was increased significantly after CLP. Plasma VA was correlated with GSH and VC, VE were correlated with MDA significantly. Conclusions: The model of CLP could ideally simulate vitamin deficiency after sepsis. The decreased antioxidation maybe the main reason of vitamin deficiency after sepsis.Experiment2-2: The Influence of Free Radicals on Vitamin Metabolismin Experimental SepsisObjectives: To determine the influence of free radicals on vitamin metabolism in experimental sepsis. Methods: Animals and experimental-8-model were the same as experiment2-l. we measured VA, VE, VC in lymphocyte, liver and intestine; MDA, GSH, and oxygen free radicals(OFR) in liver and intestine at 0,1,3,5 day after CLP, and analysed the relation of them with linear regression. Results: VA, VE, VC and GSH in tissue were decreased and MDA, OFR increased significantly after CLP. VC, GSH, MDA in tissue were correlated with OFR in tissue and VE in liver was correlated with OFR in liver. Conclusions: Free radical production after sepsis could decrease the tissue antioxidation, and then deplete the vitamins in tissue, finally result in vitamin deficiency.Part HI Therapy of vitamin deficiency in experimentalperitoneal sepsisExperiment3-l: Influence of vitamin A> E> C 梐dded TPN on vitaminmetabolism in peritoneal sepsisObjectives: To determine the influence of vitamin A, E, C 梐dded TPN on vitamin metabolism in peritoneal sepsis. Methods: A rat model of intraperitoneal infection was made by cecal ligation and puncture(CLP) in this experiment. Health male SD rats were divided into control group(CLP+TPN) , conventional...