摘要
目的了解神经源性肺水肿(NPE)患者应激激素的变化,并进一步探讨亚低温治疗NPE的临床意义。方法将脑出血致神经源性肺水肿(脑出血NPE组,52例)患者进行临床神经功能缺损评分(NIHSS)后,随机分为亚低温组(23例),常规治疗组(29例),两亚组在常规综合药物治疗基础上,亚低温组加用局部亚低温治疗;观察两亚组治疗前、治疗后第7 d血浆促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、血管加压素(AVP)以及血糖水平的应激性变化,并与脑出血无NPE组(一般脑出血组,58例)和健康对照组比较;比较脑出血NPE组2亚组治疗前、治疗后1月按美国国立卫生院神经功能缺损评分(IHSS)以判断疗效。结果脑出血NPE组和一般脑出血组患者发病时的CRH、ACTH、Cor、AVP、血糖水平均明显高于健康对照组(P<0.01);脑出血致NPE组CRH、ACTH、Cor、AVP、血糖水平均明显高于一般脑出血组(P<0.05)。在脑出血NPE组中:常规治疗组29例中,死亡15例,亚低温治疗组23例中死亡7例。两组的死亡率比较有显著性差异(P<0.01);两亚组存活患者的NIHSS评分比较有显著性差异(P<0.01);两亚组患者治疗7 d后,应激激素CRH、ACTH、Cor、AVP较治疗前明显下降(P<0.05),且亚低温治疗组应激激素水平的下降更为明显(P<0.05)。结论神经源性肺水肿(NPE)的发病与机体的应激反应有密切的关系,应激反应可能是NPE发生的基础。亚低温治疗脑出血致神经源性肺水肿不仅降低其死亡率而且提高其存活患者的生存质量。其效果可能与抑制应激和稳定下丘脑-垂体-肾上腺轴有关。
Objective to investigate the changes in stress hormones in neurogenic pulmonary edema （NPE） and explore the clinical value of mild hypothermia therapy for treatment of NPE. Methods Fifty-two patients with cerebral hemorrhage patients and concomitant NPE were randomly divided into two groups for local mild hypothermia therapy （23 cases, LMH group） or routine treatment （29 cases, RT group）. In the former group, local mild hypothermia therapy was applied in addition to the routine treatment. The changes of serum corticotrophin-releasing hormone （CRH）, adrenocorticotropic hormone （ACTH）, corticosteroid （Cor）, arginine vasopressin （AVP） and blood sugar were observed before and 7 days affer the treatment, and compared with those of 58 NPE-ffee patients with cerebral hemorrhage and 40 healthy individuals, Results Serum CRH, ACTH, Cor, and AVP levels and blood sugar in NPE patients and the NPE-ffee patients were all significantly higher than those in the healthy individuals （P〈0.01）, and the levels were significantly higher in NPE patients than in the NPE-ffee patients （P〈0.05）. In the NPE patients, the mortality rate and NIHSS score were significantly lower in RT group （P〈0.01）; after 7 days of treatment, both LMH and RT groups showed significant reduction in serum CRH, ACTH, Cor, and AVP levels （P〈0.05）, and the reduction was more conspicuous in LMH group （P〈0.05）. Conclusion The occurrence of NPE is closely associated with stress reactions, which might be the basis of NPE, Local mild hypothermia therapy improves of the quality of life of NPE patients and also decreases the mortality of NPE possibly by inhibiting the secretion of stress hormones and stabilizing the hypothalamic-pituitary-adrenal axis.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2008年第9期1696-1699,共4页
Journal of Southern Medical University
关键词
神经源性肺水肿
局部亚低温
应激激素
neurogenic pulmonary edema
local mild hypothermia
stress hormones
