CAJ | 학술논문

目的观察下丘脑-垂体-肾上腺轴(HPA)轴功能障碍对颅脑创伤患者预后的影响.方法 140例创伤性脑损伤(TBI)患者(轻型26例、中型34例、重型64例、特重型16例),TBI后第3天8:00采集2ml静脉血,于TBI后第3天24:00口服地塞米松0.75 mg,TBI后第4天的8:00再次采集2 ml静脉血,检测血清皮质醇.记录患者肺感染发生率、住院天数、格拉斯哥预后评分(GOS).结果HPA轴功能障碍发生率分别为轻型组11.6％ (3/26),中型组35.3％(12/34),重型组64.1％(41/64),特重型组81.3％ (13/16),4组之间的差异有统计学意义(x2=27.432,P＜0.01).HPA轴功能障碍组的肺感染发生率明显高于HPA轴功能良好组,差异有统计学意义(P＜0.05).HPA轴功能良好组GOS评分均值高于HPA轴功能障碍组,两组差异有统计学意义(P＜0.01).结论 HPA轴功能与TBI患者预后相关.
목적 관찰하구뇌-수체-신상선축(HPA)축공능장애대로뇌창상환자예후적영향.방법 140례창상성뇌손상(TBI)환자(경형26례、중형34례、중형64례、특중형16례),TBI후제3천8:00채집2ml정맥혈,우TBI후제3천24:00구복지새미송0.75 mg,TBI후제4천적8:00재차채집2 ml정맥혈,검측혈청피질순.기록환자폐감염발생솔、주원천수、격랍사가예후평분(GOS).결과HPA축공능장애발생솔분별위경형조11.6％ (3/26),중형조35.3％(12/34),중형조64.1％(41/64),특중형조81.3％ (13/16),4조지간적차이유통계학의의(x2=27.432,P＜0.01).HPA축공능장애조적폐감염발생솔명현고우HPA축공능량호조,차이유통계학의의(P＜0.05).HPA축공능량호조GOS평분균치고우HPA축공능장애조,량조차이유통계학의의(P＜0.01).결론 HPA축공능여TBI환자예후상관.
Objective To observe the influence of hypothalamic-pituitary-adrenal (HPA) axis on the prognosis of patients with traumatic brain injury (TBI).Methods 140 cases of TBI were fallen into the following groups:mild group (26 cases),moderate group (34 cases),severe group (64 cases),and ultra severe group (16 cases).The serum cortisol was measured at 8:00 am on the 3rd day after TBI.The dexamethasone suppression test was done to assay the stress response ability of HPA which might be injured in TBI.0.75 mg dexamethasone was taken orally or through a stomach tube at 00:00 am of the 4th day post-TBI,and then the serum cortisol was assayed at 8:00 am on the 4th day post-TBI.The rate of the pulmonary infection,average hospitalization days and Glasgow Outcome Scale (GOS) were recorded.Results The rate of HPA axis dysfunction was 11.6％,35.3％,64.1％ and 81.3％ in the mild group,moderate group,severe group and ultra severe group,respectively.The difference among the four subtypes of TBI was statistically significant(x2trend =27.432,P＜ 0.01).The rate of the pulmonary infection,average hospitalization days and GOS were respectively counted in different subtypes of TBI between the patients with normal and impaired HPA.The differences in the above items were significant (P ＜ 0.05) between the same subtypes of TBI with or without HPA axis dysfunction.Conclusion HPA axis function relates to the prognosis of TBI patients.