肾上腺皮质功能减退症患者围手术期糖皮质激素管理专家共识

• 作 者: 中华医学会内分泌学分会肥胖学组
• 出 处: 中华内分泌代谢杂志
• 发表日期: 2022年1期
• 关键词: Adrenocortical insufficiency Perioperative period Glucocorticoids

肾上腺皮质功能减退症(adrenocortical insufficiency, ACI)患者在应激时无法分泌足够的糖皮质激素(glucocorticoids, GCs)，可诱发肾上腺危象，危及生命。外科手术是重大的应激源，因此ACI患者在围手术期合理应用糖皮质激素对提高机体的应激能力、保证手术安全至关重要。但目前临床上ACI患者围手术期的GCs应用欠规范，且存在许多误区。因此，中华医学会内分泌学分会肥胖学组组织内分泌学、儿科学、麻醉学、药学等多学科专家共同制定了《肾上腺皮质功能减退症患者围手术期糖皮质激素管理专家共识》。本共识对ACI的临床诊断、激素的使用选择及ACI患者围手术期GCs的应用进行了详细阐述，并提出建议，旨在为内分泌科、外科、儿科及麻醉科医师对于ACI患者围手术期GCs规范化的管理提供参考。“,”Patients with adrenocortical insufficiency(ACI) are at significant risk of adrenal crisis and life-threatening during stress, due to the failure of cortisol secretion to cope with the increased cortisol requirement. Surgical injury is a major stressor. Thus, the perioperative GCs supplementation is essential to improve the body′s stress ability and ensure the safety of surgery. However, there were many misunderstandings and under-standards in the perioperative GCs supplementation of patients with ACI in clinical practice. Therefore, the Obesity Group of the Chinese Society of Endocrinology assembled a group of endocrinologists, anesthesiologists, pediatricians, and pharmacists to jointly draft the “ Expert consensus on the management of glucocorticoids during the perioperative period for patients with adrenal insufficiency” . The consensus elaborates and provides recommends on clinical diagnosis of ACI, the choice of GCs, and perioperative GCs supplementation for patients with ACI to promote standardized management among endocrinologists, surgeons, pediatricians, and anesthesiologists.