脑外伤后患者HPA轴功能障碍对TBI预后的影响  

Observation on the effect of hypothalamic-pituitary-adrenal axis dysfunction on the prognosis of traumatic brain injury

作　　者：赵文生 李志豪[2] 王海[2] 杜宏宇[2] 朱成[2] 

机构地区：[1]福建三博福能脑科医院,福建福州350000 [2]六安市立医院神经外科,安徽六安237000

出　　处：《中国实用神经疾病杂志》2017年第22期52-54,共3页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金项目;编号:21435002

摘　　要：目的观察脑外伤后患者下丘脑-垂体-肾上腺轴(HPA)轴功能障碍情况对创伤性脑损伤(TBI)预后的影响。方法选取福建三博福能脑科医院2012-05—2013-05收治的72例创伤性脑损伤患者为研究对象,采用地塞米松治疗后,检测血清皮质醇,皮质醇水平下降≥50%分为HPA轴功能良好组37例(其中轻型13例,中型11例,重型11例,特重型2例),皮质醇水平下降<50%为HPA轴功能障碍组35例(其中轻型1例,中型7例,重型21例,特重型6例),记录住院时间、肺部感染发生率及GOS评分。结果良好组轻型、中型、重型、特重型患者住院时间均短于障碍组,差异有统计学意义(P<0.05);良好组轻型、中型、重型、特重型患者GOS评分均高于障碍组,差异有统计学意义(P<0.05)。良好组重型患者肺部感染发生率9.09%低于障碍组47.62%,差异有统计学意义(P<0.05);2组轻型、中型、特重型患者肺部感染发生率比较差异无统计学意义(P>0.05)。结论 TBI后HPA轴功能障碍患者住院时间延长,肺部感染发生率高,患者耐受力较低,且预后较差,HPA轴功能与TBI患者预后有关。Objective To observe the effect of hypothalamic-pituitary-adrenal （HPA） axis dysfunction on the prognosis of traumatic brain injury （TBI）. Methods A total of 72 TBI cases in our hospital from May 2012 to May 2013 were selected. After hexadecadrol treatment for all patients,serum eortisol was detected. 37 cases with favorable HPA function which was defined as the decline in cortisol level to be ≥ 50% were regarded as good-function group （mild type in 13 cases, moderate type in ll cases, severe in 11 cases and extra-severe in 2 cases）, and 35 cases with HPA dysfunction （cortisol level dropping by〈50% ） were select ed as dysfunction group （mild type in one case, moderate type in 7 cases,severe in 2I cases and extra-severe in 6 cases）. Finally we recorded hospitalization stays, occurrence rate of pulmonary infection and GOS scores. Results In the good-function group, patients with mild, moderate, severe and extra-severe types showed shorter hospitalization stays and higher （/OS scores than those in the dysfunction group （all P〈0.05）. Although the occurrence rate of pulmonary infection in patients with mild, moderate and severe types between two groups showed no significant difference, patients with extra-severe type in the good-function group showed higher infection rate than those in dysfunction group （9.09 % vs 47.62 %）, and the difference was statistically significant （P〈 0.05）. Conclusion Patients with HPA axis dysfunction after TBI have prolonged hospitalization stays, high rate of pulmonary infection,bad tolerance and poor prognosis,which indicates that HPA axis function may be related to TBI prognosis.

关 键 词：脑外伤 HPA轴功能障碍 TBI 预后 肺部感染 

分 类 号：R651.15[医药卫生—外科学]