摘要
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（x^2=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.
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（x^2trend =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.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2015年第5期1162-1164,共3页
Chinese Journal of Experimental Surgery
基金
基金项目：国家自然科学青年科学基金项目（81100920、81200907）
天津市应用基础及前沿技术研究计划（12JCQNJC07200、12JCQNJC06800）
关键词
下丘脑-垂体-肾上腺轴
颅脑创伤
预后
Hypothalamic-pituitary-adrenal axis
Traumatic brain injury
Prognosis
