CAJ | 학술논문

目的：探讨氢化可的松在后腹腔镜下治疗皮质醇增多症围手术期激素替代中的应用。方法：回顾性分析36例皮质醇增多症患者在后腹腔镜手术治疗围手术期采用静滴氢化可的松随后改为口服氢化可的松的激素替代方案：术中予静滴氢化可的松100 mg，术后当天、第1 d和第2 d分别静滴氢化可的松100 mg (1次/12 h)、100 mg (1次/12 h)和100 mg(1次/d),从第2 d开始口服氢化可的松片40 mg(3次/d),逐渐减量至20 mg开始维持治疗。术后密切观察临床症状，并间断监测血、24 h尿皮质醇变化来评价该激素替代治疗效果。结果：2例出现轻微皮质功能不全症状；6例血Cor（皮质醇）低于正常范围；血钾较术前明显升高（P＜0.05）；术后第1、2 d尿Cor明显升高（P＜0.05）；第7 d尿Cor明显降低（P＜0.05）；血Cor从第2 d开始较术前降低（P值均P＜0.05）。结论：氢化可的松在腹腔镜治疗皮质醇增多症围手术期激素替代治疗中，是安全可行的。
목적：탐토경화가적송재후복강경하치료피질순증다증위수술기격소체대중적응용。방법：회고성분석36례피질순증다증환자재후복강경수술치료위수술기채용정적경화가적송수후개위구복경화가적송적격소체대방안：술중여정적경화가적송100 mg，술후당천、제1 d화제2 d분별정적경화가적송100 mg (1차/12 h)、100 mg (1차/12 h)화100 mg(1차/d),종제2 d개시구복경화가적송편40 mg(3차/d),축점감량지20 mg개시유지치료。술후밀절관찰림상증상，병간단감측혈、24 h뇨피질순변화래평개해격소체대치료효과。결과：2례출현경미피질공능불전증상；6례혈Cor（피질순）저우정상범위；혈갑교술전명현승고（P＜0.05）；술후제1、2 d뇨Cor명현승고（P＜0.05）；제7 d뇨Cor명현강저（P＜0.05）；혈Cor종제2 d개시교술전강저（P치균P＜0.05）。결론：경화가적송재복강경치료피질순증다증위수술기격소체대치료중，시안전가행적。
Objective To investigate the effect of application of hydrocortisone in hormone replacement therapy during perioperation of Cushing's syndrome after laparoscopic operation. Methods A retrospective analysis about the data and outcome of 36 cases of Cushings’s syndrome treated by intravenous dripping and oral hydrocortisone hormone replacement therapy during perioperation after laparoscopic surgery. One hundred mg hydrocortisone was given by intravenous injection during removal of adrenal adenoma,followed by 100 mg given every 12 hours at the same day,then 100 mg every 12hours on the first day and 100 mg daily on the second day after operation. Oral hydrocortisone 40 mg was given three times daily on the second day,followed by a reduction of 20 mg daily until a maintenance dosage (20 mg) was reached. After laparoscopic surgery, the clinical symptoms were closely observed, and the blood and urine cortisol levels were intermittentty monitored to evaluate the therapeutic effect of the hormone re-placement therapy. Results Two cases had slight cortical dysfunction symptoms; six patients had blood corti-sol levels lower than those of the first and second days after surgery(P<0.05); on the seventh day reduced sig-nificantly below the normal range; the serum potassium level of postoperation was significantly higher than that of preoperation(p<0.05); the urinary cortisol level of postoperation was significantly higher(P<0.05); the se-rum cortisol level began to reduce significantly on the second day after surgery(P<0.05). Conclusion The effect of hydrocortisone in hormone replacement therapy during perioperation of Cushing's syndrome after laparo-scopic operation is safe and feasible.