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目的探讨早期应用氢化可的松对急性中、重型颅脑损伤患者肾上腺皮质功能的影响。方法将50例患中、重型颅脑损伤患者分为观察组和对照组各25例。对照组进行常规治疗;观察组在对照组的基础上,于患病早期(3 h内)给予氢化可的松,剂量为2 mg/(kg·d),分3次执行,配生理盐水至0.2 mg/m L,共用3 d。检测用药后不同时间点血浆皮质醇、血糖、C反应蛋白水平及白细胞数量的变化;7 d后对患者进行促肾上腺皮质激素(ATCH)刺激试验,检测血浆皮质醇含量,判断患者肾上腺皮质醇功能恢复情况。结果两组患者在入院初期血浆皮质醇、血糖、C反应蛋白水平及白细胞数量较高,治疗后观察组该4项指标较治疗前显著降低(P<0.05),与对照组同时间点比较亦显著降低(P<0.05)。ATCH刺激后,观察组皮质醇水平增加量高于对照组(P<0.05)。结论氢化可的松可显著降低早期急性中、重型颅脑损伤患者血浆皮质醇、血糖、C反应蛋白水平及白细胞数量,有助于患者肾上腺皮质功能恢复,具有良好的治疗作用。
Objective To investigate the effect of early application of hydrocortisone on adrenocortical function in patients with acute severe traumatic brain injury. Methods Fifty patients with moderate and severe craniocerebral injury were divided into observation group and control group with 25 cases each. The control group was treated routinely. On the basis of the control group, hydrocortisone was given to the observation group at the early stage of the disease (within 3 h) at a dose of 2 mg / (kg · d) for 3 times with normal saline 0.2 mg / m L for 3 days. The changes of plasma cortisol, blood glucose, C-reactive protein and leukocyte counts at different time points were measured. After 7 days, the patients were subjected to adrenocorticotrophic hormone (ATCH) stimulation test, plasma cortisol level was measured to determine the adrenal cortisol function Restore the situation. Results The plasma cortisol, blood glucose, C-reactive protein and the number of white blood cells in the two groups were significantly higher after admission. The four indexes in the observation group were significantly lower than those before treatment (P <0.05) Significantly lower (P <0.05). After ATCH stimulation, the increase of cortisol level in the observation group was higher than that in the control group (P <0.05). Conclusion Hydrocortisone can significantly reduce the plasma cortisol, blood glucose, C-reactive protein levels and the number of leukocytes in patients with acute and severe acute craniocerebral injury in early stage, which is helpful for the recovery of adrenocortical function and has a good therapeutic effect.