不同病情程度颅脑损伤患者血清皮质醇浓度动态变化及临床意义的研究  

Clinical significance of dynamic serum cortisol level in patients with different severity of brain injury

作　　者：王俊杰[1] 张祖勇[2] 

机构地区：[1]绍兴市人民医院急诊外科,浙江绍兴312000 [2]杭州市第一人民医院神经外科,浙江杭州310006

出　　处：《中华全科医学》2018年第3期410-412,共3页Chinese Journal of General Practice

基　　金：浙江省医药卫生一般项目(2012KYB148)

摘　　要：目的动态检测不同病情严重程度颅脑损伤患者血清皮质醇浓度的变化情况,并分析其临床意义。方法选择2016年1—6月收治的60例颅脑损伤患者作为研究对象,根据格拉斯哥昏迷评分法(glasgow coma scale,GCS)将患者分为轻度组(GCS 13~15分)、中度组(GCS 9~12分)及重度组(GCS 3~8分)。于伤后1、3、7和14 d的早上8:00连续采取静脉血,采用ELISA法检测血清皮质醇浓度。随访6个月后,分析其与患者预后的关系。结果轻度及中度组患者血清皮质醇浓度多在正常范围,且变化幅度小,而重度组变异度最大,差异有统计学意义(F=11.325,P<0.01)。同时,结果显示各组患者血清皮质醇浓度在前一周内变化幅度最大,此后逐渐趋于正常。皮质醇正常、升高及下降的患者例数分别为28例、26例及6例;同时,根据本研究对预后的定义,预后不良者共11例,预后良好者共49例。皮质醇浓度正常和上升组预后良好率为87.0%,显著高于皮质醇浓度下降组(33.3%),提示皮质醇浓度降低者预后更差,差异有统计学意义。结论颅脑损伤越重,患者血清皮质醇浓度变异度越大,预后越差。Objective To detect the dynamic serum cortisol level and evaluate its clinical significance in the patients with traumatic brain injury（ TBI）. Methods Total 60 cases of traumatic brain injury in our hospital from January,2016 to June,2016 were included,and were classified into three groups according to the Glasgow Coma Scale（ GCS） ： mild,moderate（ GCS 13-15） and severe group（ GCS 9-12） after admittance（ GCS 3-8）. The blood sample of those patients were collected in the morning 8 am on 1 d,3 d,7 d,14 d,and 6 months later; the level of serum cortisol was tested by using chemiluminescence immunoassay. Results The serum cortisol concentrations in patients with mild and moderate groups were in the normal range,and the change range was small,while the severe group had the greatest degree of variation（ F = 11. 325,P 0. 01）. The change of the serum cortisol concentration of the patients in the first 1 week was the largest,and then gradually became normal. The number of patients with normal cortisol,rising or falling levels of cortisol were 28 cases,26 cases and 6 cases,respectively. According to the definition of the prognosis,there were 11 patients with poor prognosis,49 patients with good prognosis. The good rate was 87% in the normal and ascending group of cortisol concentration,which was significantly higher than that in the lower cortisol group（ 33. 3%）,which indicated that the lower the concentration,the worse the prognosis. Conclusion The cortisol levels changed more significantly with the severity of TBI,and the patients with low serum cortisol level usually had poor outcomes.

关 键 词：颅脑损伤 血清皮质醇 预后 

分 类 号：R651.15[医药卫生—外科学]