重度颅脑损伤时血清胃泌素、皮质醇变化与消化道出血的关系

Relationship Between the Change of Serum Gastrin and Cortisol Levels and Gastrointestinal Bleeding in Patients with Severe Head Injury

【目的】研究重度颅脑损伤血清胃泌素、皮质醇变化与消化道出血关系。【方法】用放射免疫法对108 例重度颅脑损伤及同时伴消化道出血患者和30 例健康人血清中胃泌素、皮质醇测定。【结果】重度颅脑损伤患者在早期,胃泌素、皮质醇均明显高于健康对照组( P < 0 .01) ,且皮质醇与昏迷程度呈正相关系。108 例中有32 例发生消化道出血,其应激期内皮质醇、胃泌素均明显增高,应激期后消化道出血者仅胃泌素增高。【结论】应激期内消化道出血与高皮质醇、高胃泌素有关,而应激期后的消化道出血则与高胃泌素,低氧血症,电解质紊乱,高血糖,肝肾功能障碍等有关。

Objective To study the relationship between the change of serum gastrin and cortisol levels and gastrointestinal bleading in patients with severe head injury (SHI). Methods The serum gastrin and cortisol levels were estimated by radioimmunoassay (RIA) in 108 SHI patients accompanied with gastrointestinal bleeding and also in 30 healthy subjects. Results The serum gastrin and cortisol levels at the early stage of SHI were significantly higher than those of normal controls (P<0.01).Moreover,the cortisol levels was not positively correlated with the severity of coma.In 32 patients with gastrointestrinal bleeding,their serum gastrin and cortisol levels distinctly increased during stress period,but elevated gastrin levels were only found after stress period. Conclusion gastroitestinal bleeding in SHI patients is correlated well with their serum gastrin and cortisol levels within stress period;whereas the gastrointestinal bleeding after stress period is related to hypergastrinemia,hypoxia,hyperglycemia,electrolyte disorders.and reno hepatic disfunction.