颅脑损伤后应激不良的临床研究

The study of harmful stress after traumatic brain injury

目的研究颅脑损伤(TBI)后应激不良发生的情况。方法分析271例TBI患者伤后3 d 8∶00的基础皮质醇(COR)水平,并于伤后3 d 24∶00时予地塞米松0.75 mg口服,并测定伤后4 d 8∶00的COR水平,若COR下降未达到其正常值的50%,即确定发生应激不良反应。结果轻型、中型、重型和特重型TBI应激不良发生率分别为0%(0/31)、12.28%(7/57)、32.48%(38/117)、40.91%(27/66),4组间比较差异有统计学意义(P<0.05)。应激良好组的医院肺部感染发生率、平均住院天数和格拉斯哥预后评分分别为6%、(8.91±1.46)d和(4.3±0.3)分(中型),11.39%、(14.71±2.23)d和(3.5±0.3)分(重型),48.72%、(29.64±4.86)d和(3.1±0.3)分(特重型);应激不良组分别为28.57%、(12.75±2.19)d和(3.9±0.2)分(中型),34.31%、(19.94±3.96)d和(3.1±0.3)分(重型),74.07%、(39.27±7.14)d和(2.5±0.2)分(特重型),应激良好组和不良组间比较差异有统计学意义(P<0.05)。结论随着TBI严重程度,应激不良发生率明显增高;应激良好组的平均住院天数、肺部感染发生率及预后明显优于应激不良组。

Objective To study the harmful stress after traumatic brain injury. Methods The levels of 271 patients＇ serum cortisol at 8 ： 00 3 d after traumatic brain injury were taken as basal cortisol levels; patients were administrated dexamethasone 0. 75 mg at 24 ： 00 3 d after injury, cortisol levels at 8 ： 00 4 d after injury ; the harmful stress was determined. Results In the mild, medium, severe and highly severe traumatic brain injuries, the harmful stress incidences were 0% （0/31） ,12. 28% （7/57） ,32.48% （38/117） ,and 40. 91% （27/66） ;differences among the four groups were statistically significant （ P 〈 0.05 ）. In addition, the beneficial stress group＇ s hospital pulmonary infection rate, average days of hospitalization and GOS were 6% , 8.91 ± 1.46 and 4. 3 ± 0.3 （ medium）, 11.39%, 14. 71 ±2.23 and 3.5 ±0. 3 （severe）, 48.72% ,29.64 ±4. 86 and 3.1 ±0. 3 （highly severe）. The harmful stress group＇ s hospital pulmonary infection rate, average days of hospitalization and GOS were 28.57% ,12.75 ±2. 19 and 3.9 ±0. 2 （medium） ,34.31% ,19.94 ±3.96 and 3.1 ±0.3 （severe） ,74. 07% ,39.27 ± 7. 14 and 2.5 ± 0. 2（ highly severe）, and the difference was statistically significant （P 〈 0. 05 ） between beneficial groups and harmful groups. Conclusion Significantly increased with the severity of traumatic brain injure, the harmful stress incidence rate enhances; the beneficial stress group average days of hospitalization and hospital pulmonary infection incidence are significantly superior to the harmful stress group.