老年病人术后相对性肾上腺皮质功能不全与术后并发症  

The relative adrenal insufficiency in the old postoperative critically ill patients and the complications

作　　者：魏宏建[1] 徐尤年[1] 

机构地区：[1]昆明医学院第一附属医院加强治疗科,云南昆明650032

出　　处：《云南医药》2008年第1期3-5,共3页Medicine and Pharmacy of Yunnan

基　　金：云南省科研基金项目资助(5Y0457C)

摘　　要：目的观察老年术后危重病人中相对性肾上腺皮质功能不全(RAI)的发生率及肾上腺皮质功能不全和术后并发症发生率之间的关系。方法选择年龄≥65周岁,术后直接入住昆明医学院第一附属医院ICU,APACHEⅡ评分≥8分的危重病人40例为研究对象。术后进入ICU第1天10时抽取血进行血清总的皮质醇、醛固酮、血糖、血钠、血钾、白蛋白检测,并进行ACTH刺激实验。记录患者年龄、性别、并发症、APACHEⅡ、中心静脉压和入住ICU的时间。取门诊体检健康老人40例作为对照组,测老年人血清总的皮质醇浓度基础值。结果1.老年术后危重病人RAI的发生率高达47.5%(19/40),病人没有典型的电解质变化,平均入住ICU8.8天。2.RAI组中,发生低血压和呼吸功能不全各有10例,感染9例,消化道出血6例;肾上腺皮质发应良好组(Non-RAI)中有4例患者发生低血压(19.05%),呼吸功能不全有7例(71.43%),感染3例,消化道出血5例;感染和低血压发生率差异有统计学意义。3.血清总的皮质醇浓度跟患者病情严重程度正相关。结论相对性肾上腺皮质功能不全在老年术后危重病人中有较高的发生率,相对肾上腺皮质功能不全增加了术后低血压和感染的发生率。老年术后危重病人基础皮质醇浓度跟病情严重程度正相关。Objective To examine the incidence of relative adrenal insufficiency（RAI） in old postoperative patients and explore the relationship between serum total cortisol and the postoperative complications. Methods 40 old postoperative patients （above 65 years old） were enrolled in this study. Blood was drawn at 10：00 o＇clock on the 1^st day to detect the serum concentrations of the corticoid, natrium, potassium, sugar and albumin. Then the ACTH stimulation tests were carried out （according to the instruction of the First Biochemical Pharmaceuticals Company of Shanghai） At the same time, the data, such as sex, age, diagnosis, complications, APACHE Ⅱ scoring, central venous pressureand stay time in ICU were recorded. Serum concentrations of corticoid of 40 healthy patients were detected as controis. Results 1. 47.5% （19 cases） of the postoperative old patients met the described criteria for RAI （total cortisol increment after ACTH stimulation test ≤ 9 μg/dl） . None of the 40 cases who stayed in ICU for average 8.8 days had the classic electrolyte changes, such as hyponatremia and hypercalemia. 2. The difference of the hypotension incidence between the RAI group and the Non-RAI group was significant （52.6% vs.19.05%, P = 0.026） . Other complications between the two groups were not significantly different （42.10% vs.33.30%, P = 0.57） . 3. The basical cortisol concentrations after operation were significantly related with the disease severity. Conclusions The incidence of RAI in old postoperative patients is high but with no classic clinical signs and electrolyte changes. The patients with RAI have higher risk of hypotension. The basical cortisol concentrations after operation were significantly related with the disease severity.

关 键 词：肾上腺皮质功能不全 危重病人 老年人 术后并发症 

分 类 号：R568.1[医药卫生—呼吸系统]