脑神经外科长时间手术患者围术期应用皮质类固醇的影响

Effects of methylprednisonlone on plasma corticosteroid in perioperative patients undergoing long time cerebraneurosurgery

目的:探讨脑神经外科长时间手术患者围术期应用激素对血浆皮质类固醇(COR)的影响。方法:择期长达12h以上的手术35例,随机分为2组,激素组(n=20)于手术开始时静注甲强龙40mg;对照组(n=15)静注等量生理盐水。所有患者采用静脉复合全身麻醉,分别于术前(基础值)、插管时、术中每4h(超过16h不再测量)、术毕、术后1、3d各抽静脉血4ml测血浆COR浓度。结果:术后1d激素组与对照组COR相比差异有统计学意义(P<0.05)。激素组与对照组COR术后1d与术前相比差异均有统计学意义(P<0.05)。结论:脑神经外科长时间手术麻醉期间给予一定量的激素,可保护患者内源性肾上腺皮质的释放功能,防止术后第1天COR下降。

Objective： To investigate the effects of methylprednisonlone on plasma corticosteroid in perioperative patients undergoing long time cerebraneurosurgery. Methods： 35 patients whose operative time were more than 12 hours were randomly divided into 2 groups：hormone group （n=20）： methylprednisolone 40 mg was given at the beginning of the operation; control group （n=15）： equal dose normal saline was used. All the patients were given general anesthesia. Venous blood samples were taken before the anesthesia （baseline）, tracheal intubation, during the operation per 4h, 1 day and 3 day after the operation for detecting the concentration of the corticosteroid. Results： Compared with the control group, the concentration of the corticosteroid was significantly higher in the hormone group （P〈0.05）; moreover, compared with the baseline value, the concentration of the eortieosteroid were significant difference in 1 d after the operation in both groups （P〈0.05）. Conclusion： Application of methylprednisolone at the begining of the operation can protect the function of the adrenal cortex and avoid the downregulation of the corticosteroid in ld after the operation.