甲强龙对重型颅脑损伤患者肾上腺皮质功能的影响

Effect of methylprednisolone on adrenal cortex function in patients with severe craniocerebral injury

目的探讨甲强龙对重型颅脑损伤患者肾上腺皮质功能的影响。方法将82例重型颅脑损伤患者分为观察组和对照组,每组41例。两组均给予常规治疗,观察组患者于入院3 h内加用2 mg/(kg·d)甲强龙,3次/d,连用7 d。分别于入院时及用药后6 h、第1天、第3天、第7天检测两组患者血浆游离皮质醇、C反应蛋白(CRP)水平及白细胞计数。用药7 d后对两组进行促肾上腺皮质激素(ACTH)刺激试验,通过游离皮质醇含量检测肾上腺皮质功能。比较用药期间两组患者肺部感染发生情况。结果两组患者用药后皮质醇、CRP水平、白细胞计数和小剂量促肾上腺素刺激试验后的皮质醇水平比较,差异均有统计学意义(均P<0.05),均有随时间变化的趋势(均P<0.05),分组与时间均有交互效应(均P<0.05);观察组用药后6 h、第1天、第3天皮质醇水平均低于对照组(均P<0.05),用药后第1天、第3天CRP水平及白细胞计数均低于对照组(均P<0.05),用药7 d后促肾上腺素刺激后30 min、60 min、90 min皮质醇水平均高于对照组(均P<0.05)。两组肺部感染发生率差异无统计学意义(P>0.05)。结论采用甲强龙治疗重型颅脑损伤能降低患者血浆皮质醇、CRP水平及白细胞计数,改善肾上腺皮质功能,且不增加肺部感染发生率。

Objective To investigate the effect of methylprednisolone on adrenal cortex function in the patients with severe eranioeerebral injury. Methods A total of 82 patients with severe eranioeerebral injury were divided into observation group and control group,with 41 eases in each group. Both groups received conventional treatment, and the observation group was treated with 2 ing/（ kg · d） of methylprednisolone additionally within 3 hours after admission,3 times per day for 7 days. The levels of plasma flee eorfisol and C-reactive protein （CRP） as well as the WBC count were detected on admission at 6 h, 1 day,3 days and 7 days after medication. After 7 days of medication, adrenoeorfieotropie hormone（ACTH） stimulation test was performed in the two groups,and the adrenoeorfieal function was determined based on the content of free eorfisol. The incidence of pulmonary infection was compared between the two groups during medication. Results There were statistically signifieant differences in the levels of eorfisol and CRP,WBC count,mid eorfisol level after low-dose ACTH stimulation test between the two groups （ all P 〈 0. 05 ）, presenting a tendency to change over time （ all P 〈 0.05 ） ,and there was an interaction between grouping effect and time effeet（P 〈0. 05） ;at 6 h,1 day and 3 days after medication,the eorfisol levels in the observation group were lower than those in the control group（all P 〈0.05） ;at 1 day and 3 days after medication,the CRP levels and WBC counts in the observation group were lower than those in the control group（ all P 〈0. 05 ）;at 30,60 and 90 rain after ACTH stimulation test, the eorfisol levels in the observation group were significantly higher than those in the control group at 7 days after medication（ all P 〈 0.05 ）. There was no significant difference in the incidence rate of pulmonary infection between the two groups （P 〉 0.05）. Conclusion The methylprednisolone therapy can reduce plasma eorfisol and CRP levels and WBC count,improve adrenal cortex function, and does not increase the incidence rate of pulmonary infection in the patients with severe eranioeerebral injury.