摘要：
目的 通过观察急性颅脑损伤患者心脏功能的变化及其与血浆神经肽Y(NPY)的关系,探讨其机制. 方法 选择符合诊断标准的急性颅脑损伤患者89例为观察组,根据GCS评分分成重度组(47例)和轻度组(42例);同时选取健康体检正常者35例为对照组.观察组在损伤24 h、72 h分别做超声心动图评价左心室收缩、舒张功能,并与对照组比较,同时采用放射免疫分析法检测各组血浆NPY水平. 结果 急性颅脑损伤后24 h及72 h左室射血分数(EF)、每搏输出量(SV)、主动脉瓣口峰流速(AV)、每分钟心输出量(CO)、心脏指数(CI)等各心功能参数重度组与轻度组、对照组差异均有统计学意义(均P＜0.05),轻度组与对照组上述指标均无统计学意义(均P＞0.05);血浆NPY水平在轻度组与重度组间、对照组与重度组间差异均有统计学意义(均P＜0.05).经直线相关分析,血浆NPY水平升高与心功能参数变化呈负相关系(EF:r=-0.79,SV:r=-0.71,AV:r=-0.67,E/A:r=-0.63,均P＜0.01;CO:r=-0.32、CI:r=-0.35,均P＜0.05). 结论 急性重度颅脑损伤患者心脏功能下降明显,且与NPY水平相关.%Objective To observe the cardiac function in acute brain injury patients(ABI)and the relationship between ABI and plasma neuropeptideY(NPY),and to inspect the mechanism and find the evidences for preventing cardiac impairment caused by ABI. Methods 89 patients with acute brain injury within 24 hours after the injury were divided into severe group(n =47)and mild group(n = 42)according to Glasgow Coma Scale(GCS),and 35 normal healthy adults were selected as control group.In 24 hours and 72 hours after the brain injury,all patients were examined with echocardiography to observe cardiac structure,Doppler blood flow velocity and cardiac function,and in the same time the plasma NPY were determined by radioimmunoassay.Then the results were compared with controls. Results The parameters of cardiac function such as EF、 SV.AV、CO、CI had statistical change in 24 hours and 72hours after the brain injury between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P <0.05),but no statistical change between mild ABI group and control group(all P ＜0.05).The level of plasma NPY in ABI patients was significantly higher than that before injury,there was statistically different change between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P＜0.05).The parameters of cardiac function was negatively correlated with the rise of plasma NPY by pearson correlation analysis(EF:r =- 0.79,P <0.01; SV:r =- 0.71,P <0.01;AV:r=-0.67,P ＜0.01 ;E/A:r =-0.63,all P ＜0.01)and(CO:r =- 0.32,P ＜0.05;CI:r =-0.35,all P ＜0.05). Conclusion The parameters of cardiac function were significantly decreased in the patients with acute brain injury,and it was closely related with the level of plasma NPY.
