单侧肾上腺切除术后一过性皮质功能不全的临床表现及处理分析

Analysis of the clinical manifestations and treatment for transient adrenal insufficiency after unilateral adrenalectomy

目的：探讨单侧肾上腺切除术后患者一过性皮质功能不全的临床表现及处理。方法：分析我院2014年4月~2015年4月期间,因单侧无功能肾上腺区占位行手术后出现一过性皮质功能不全患者的临床资料及术后处理。结果：21例患者中术后出现一过性皮质功能不全患者13例（血清皮质醇〈9μg/dl）,余8例患者未出现皮质功能不全（血清皮质醇≥9μg/dl）,两组患者术后3天最高体温分别为（38.32±0.80）℃和（37.69±0.48）℃,两组差异具有统计学意义（P=0.043）,术后第1天白细胞计数分别为（10.65±4.34）×109和（7.12±2.23）×109两组差异具有统计学意义（P=0.046）,术后3天平均动脉压（111.88±17.02）mmHg和（113.83±17.02）mmHg,两组差异无统计学意义（P=0.147）,术后第1天血钾（3.54±0.31）mmol/L和（3.59±0.45）mmol/L,两组差异无统计学意义（P=0.175）。针对皮质功能不全患者若术后出现发热（≥38.5℃）,给予氢化可的松第1天100mg,第2、3天50mg静滴后停药,症状均得到缓解。结论：因单侧无功能肾上腺区占位行手术切除肾上腺的患者术后一过性肾上腺皮质功能不全是导致患者术后早期发热（≥38.5℃）、白细胞升高、血压偏低的一个重要因素,针对此类患者可短期补充皮质激素改善症状,加快患者术后恢复。

Objective：To investigate the clinical manifestations and treatment for transient adrenal insufficiency after unilateral adrenalectomy.Method：21patients underwent adrenalectomy for nonfunctional mass of the adrenal area were reviewed.The cases came from Department of Urology,Peking University Peoples Hospital from April,2014 to April,2015.Result：13of the 21 patients suffered from transient adrenal insufficiency（Group 1）,while the other 8patients not（Group 2）,The difference of temperature and WBC betweent the two group is of significant（P =0.043,P =0.046）.For those patients who underwent fever of group 1treated with short-term cortisol is effective.Conclusion：Transient adrenal insufficiency after unilateral adrenalectomy may result in early postoperative fever,WBC increasing and hypotension,short-term cortisol using may accelerate the recovery of the patients.