Kehlet H
Acta Anaesthesiol Scand. 1975;19(4):260-4. doi: 10.1111/j.1399-6576.1975.tb05182.x.
A rational physiological schedule for parenteral glucocorticoid substitution therapy during surgical procedures is proposed based on the principle of imitating the normal hypothalamic-pituitary-adrenocortical response to surgery. The schedule includes the injection of 25 mg cortisol intravenously in all patients together with induction of anaesthesia. Following major surgery, 100 mg cortisol dissolved in saline or glucose is continuously infused intravenously every 24 hours until gastrointestinal function permits oral intake of usual glucocorticoid substitution therapy. In case continuous cortisol infusion is undesirable, 25 mg cortisol is injected intravenously every four hours. Following minor surgery, usual oral glucocorticoid therapy is started immediately after the operation. It is recommended to use water-soluble cortisol preparations and not cortisone acetate, which results in limited plasma cortisol levels.
基于模拟下丘脑-垂体-肾上腺皮质对手术的正常反应这一原则，提出了手术期间胃肠外糖皮质激素替代治疗的合理生理方案。该方案包括在所有患者麻醉诱导时静脉注射25毫克皮质醇。大手术后，将100毫克溶解于生理盐水或葡萄糖中的皮质醇每24小时持续静脉输注，直至胃肠功能允许口服常规糖皮质激素替代治疗。若不适合持续输注皮质醇，则每四小时静脉注射25毫克皮质醇。小手术后，术后立即开始常规口服糖皮质激素治疗。建议使用水溶性皮质醇制剂，而非醋酸可的松，因为醋酸可的松会导致血浆皮质醇水平有限。
