严重烧伤后下丘脑-垂体-肾上腺皮质轴激素改变的临床观察

Clinical study on the postburn change in the hypothalamus-pituitary-adrenal hormones in severely burned patients

目的 动态观察严重烧伤患者下丘脑 垂体 肾上腺皮质轴激素水平的变化 ,为临床治疗和预后提供理论依据。 方法 选择 5 0例严重烧伤患者 ,用放射免疫法分别测定其伤后不同时间血浆总皮质醇 (GC)、促肾上腺皮质激素 (ACTH)、醛固酮 (ALDO)和尿 17 羟皮质类固醇 (17 OH)、尿17 酮类固醇 (17 KS)的含量 ,以各项指标的正常值为对照 ,结合所得数据进行统计学分析。 结果 严重烧伤后 ,患者激素水平均显著升高 ,出现休克期和感染期两个高峰 ;6周后大部分激素水平低于正常值 ;患者死亡前激素水平极低 ,而创面愈合者则逐渐趋于正常。 结论 严重烧伤后 ,下丘脑 垂体 肾上腺皮质轴激素水平呈持续性上升 ;休克和感染是烧伤后机体应激反应的两个主要因素 ;如激素含量骤然下降至正常水平以下 ,表明肾上腺皮质功能已处于衰竭状态 ,死亡率极高。

Objective To investigate the postburn dynamic changes in the hypothalamus-pituitary-adrenal hormones in severely burned patients. Methods Fifty burn patients were enrolled in the study. The plasma contents of total GC (cortisol), ACTH and aldosterone (ALDO) and urinary contents of 17-OHO and 17-KS were determined with radio-immunological assay (RIA) method after burn injury to compare with the normal values which were well established clinically. Results The postburn plasma and urinary contents of the above indices were increased evidently with two peak values in shock and infectious stages, whilst the majority of he indices were lower than the normal values after 6 postburn weeks(PBWs). The values of these hormones were the lowest in dying patients. On the other hand, the values approached normal levels in those patients whose burn wounds were healing. Conclusion Increases of the plasma and urinary levels of hypothalamus-pituitary -adrenal hormones in severely burned patients were constantly seen. Burn shock and infection seemed to be the two major factors in inducing postburn stress reaction in burn victims. Abrupt decrease of the hormone levels in plasma and or urine indicated adrenal failure predicting a poor prognosis of the burn patients.