Ascorbic acid dynamics in the seriously ill and injured
Ascorbic acid dynamics in the seriously ill and injured
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DOI：
10.1016/s0022-4804(02)00083-5
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发表时间：
2003-02-01
影响因子：
2.2
通讯作者：
Sauberlich, HE
中科院分区：
文献类型：
--
作者：
Long, CL;Maull, KI;Sauberlich, HE
背景资料。除了已知的抗坏血酸对伤口愈合和免疫反应的有益作用外，它还是一种有效的细胞外抗氧化剂。最近对脓毒症大鼠的研究表明，补充大剂量抗坏血酸的全肠外营养(TPN)可以保护细胞免受自由基损伤，提高存活率。在这项研究中，我们测定了损伤/疾病后即刻的抗坏血酸水平，并评估了早期短期高水平的抗坏血酸在TPN中使血浆水平正常化的能力。测定了12例严重创伤患者和2例严重外科感染患者的抗坏血酸水平。每个患者在6天的时间内接受TPN并增加剂量的抗坏血酸。治疗反应通过高压液色谱检测血浆和尿液来确定。服用300 mg/d补充剂2天后，平均血浆抗坏血酸浓度降低(0.11+/-0.03 mg/dl)，无反应(0.14+/-0.03 mg/dl；P=1.0)；服用1000 mg/d补充剂2天后，血浆抗坏血酸水平仅接近正常水平(0.32+/-0.08；P=0.36)。3000mg2天后显著增加(1.20±0.03；P=0.005)。我们证实创伤和感染后血浆抗坏血酸水平极低。这种维生素的最大早期补充需要在损伤后早期使用超生理剂量快速填充3天或更长时间。(C)2003年埃尔塞维尔科学公司(美国)。
Background. In addition to the known beneficial effects of ascorbic acid on wound healing and the immune response, it is also a potent extracellular antioxidant. Recent work in septic rats suggests that highdose ascorbic acid total parenteral nutrition (TPN) supplementation may protect cells from free radical injury and improve survival. In this study, we determined ascorbic acid levels in the immediate post-injury/illness period and evaluated the ability of early short-term high levels of ascorbic acid in TPN to normalize plasma levels.Materials and Methods. Ascorbic acid levels were determined in 12 critically injured patients and 2 patients with severe surgical infections. Each patient received TPN supplemented with increasing doses of ascorbic acid over a 6-day period. Therapeutic responses were determined by plasma and urine measurements using high-pressure liquid chromatography.Results. The initial mean +/- SEM baseline plasma ascorbic acid concentration was depressed (0.11 +/- 0.03 mg/dl) and unresponsive following 2 days on 300 mg/ day supplementation (0.14 +/- 0.03; P = 1.0) and only approached low normal plasma levels following 2 days on 1000 mg/day (0.32 +/- 0.08; P = 0.36). A significant increase was noted following 2 days on 3000 mg/day (1.2 +/- 0.03; P = 0.005).Conclusion. We confirmed extremely low plasma levels of ascorbic acid following trauma and infection. Maximal early repletion of this vitamin requires rapid pool filling early in the post-injury period using supraphysiologic doses for 3 or more days. (C) 2003 Elsevier Science (USA).