儿童创伤性脑损伤后血清皮质醇的变化及对预后的影响  

The changes of serum cortisol and its influence on prognosis in children with traumatic brain injury

作　　者：张明[1] 杨毅[2] 陆巍峰[3] 张琴[4] Zhang Ming Yang Yi Lu Weifeng Zhang Qin(Department of Southeast University School of Medicine, Nanjing 210009, China)

机构地区：[1]东南大学医学院,南京210009 [2]东南大学附属中大医院重症医学科,南京210009 [3]南京医科大学附属南京儿童医院外科ICU,210008 [4]南京医科大学附属南京儿童医院外科PICU,210008

出　　处：《中国小儿急救医学》2017年第2期123-127,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的研究儿童创伤性脑损伤（traumatic brain injury，TBI）后血清皮质醇的变化规律，以及对预后的影响。方法2014年6月至2015年12月伤后24 h内入住南京市儿童医院外科ICU的52例TBI患儿，按照格拉斯哥昏迷评分（glasgow coma scale，GCS）分为轻度损伤组（19例，GCS评分≥13分）、中度损伤组（16例，8分〈GCS评分〈13分）、重度损伤组（17例，GCS评分≤8分）。患儿入ICU第1、3、7天晨6时留取外周静脉血检测血清促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）、皮质醇浓度，并记录患儿入组时的一般情况、生命体征、小儿危重症评分、儿童创伤评分、循环指标（平均动脉压）、代谢指标（总蛋白、白蛋白、血糖等）、呼吸指标（pH、PaO2、PaO2/FiO2）、ICU住院时间、总住院时间、28 d病死率等。结果（1）3组患儿GCS评分、小儿危重症评分、儿童创伤评分、心率、血糖、白细胞计数比较差异均有统计学意义（P均〈0.05）；年龄、体重、平均动脉压、pH、PaO2、PaO2/FiO2、总蛋白和白蛋白比较差异均无统计学意义（P〉0.05）。（2）各组TBI患儿早期皮质醇浓度均明显升高，随后逐渐下降，并在1周内恢复至正常水平；而各组ACTH水平伤后也有不同水平升高。重度及中度损伤组患儿入院第1天血清ACTH、皮质醇浓度均显著高于轻度组[分别为ACTH：（44.19±9.41）pg/ml，（29.91±5.49）pg/ml，（9.47±2.32）pg/ml；皮质醇：（48.57±3.63）mg/dl，（40.94±2.95）mg/dl，（25.14±1.76）mg/dl]，差异有统计学意义（P〈0.05）；之后除第3天中度损伤组与轻度损伤组皮质醇浓度[（27.54±3.24）mg/dl比（19.36±2.36）mg/dl]比较差异有统计学意义外，其他组间比较差异均无统计学意义（P〉0.05）。（3）3组患儿机械通气时间、休克持续时间、ICU住院时间、总住院时间比较差异均有统计学意义（P〈0.05）。3组患儿均救�Objective To explore the changes of serum cortisol and its influence on prognosis in children with traumatic brain injury （TBI）. Methods A total of 52 children suffering from TBI hospitalized in SICU of Nanjing Children＇s Hospital from June 2014 to December 2015 were analyzed. According to the glasgow coma scale（GCS）,they were divided into three groups： mild injury group（ 19 cases, GCS ≥13 ）, moderate injury group （ 16 cases, 8 〈 GCS 〈 13 ）, and severe injury group （ 17 cases, CJCS ≤ 8 ）. We collected the data of the following clinical parameters on the 1 st,3rd,7th day after hospitalization：the levels of serum adrenocorticotropic hormone （ACTH） and cortisol, general vital signs, pediatric critical illness score, paediatric trauma score, cycle index （mean arterial pressure ）, metabolic index （total protein, albumin, blood sugar）, respiratory index （ pH, PaO2, PaO2/FiO2 ） , ICU length of hospital stay, the total length of hospital stay, 28 days case fatality rate. Results （ 1 ） There were significant differences in the scores of GCS, pediatric critical iUness score,pediatric trauma score, heart rate,blood glucose and white blood cell count among three groups （ P 〈 0. 05 ）. But the age, body weight, mean arterial pressure, pH, PaO2, PaO2/FiO2, total protein and albumin showed no statistically significant difference （ P 〉 0.05, respectively ）. （ 2 ） The levels of cortisol in children with TBI increased （24 hours） at early stage, and then gradually dropped to normal within one week.The levels of ACTH were also elevated after injury. The levels of serum ACTH and cortisol in severe and moderate injury group were significantly higher than those in the mild group[ ACTH： （44. 19 ± 9.41 ） pg/ml, （29.91 ±5.49） pg/ml, （9.47 ± 2. 32） pg/ml; cortisol： （48.57 ±3.63） mg/dl, （40.94 ±2.95） mg/dl, （25.14 ± 1.76） mg/dl], the differences were statistically significant （ P 〈 0. 05 ）. Afterward, the levels of cortisol were

关 键 词：儿童 创伤 颅脑损伤 皮质醇 

分 类 号：R726.5[医药卫生—儿科]