Rhodes Jonathan K J
Intensive Care Unit, Western General Hospital, Edinburgh, Scotland, UK.
Curr Opin Crit Care. 2003 Apr;9(2):86-91. doi: 10.1097/00075198-200304000-00002.
Despite 25 years of randomized, controlled trials, the benefit of steroid administration to patients with traumatic brain injury is unproved. Traditionally, glucocorticoids have been used empirically to reduce inflammation and edema. However, it is becoming apparent that the mechanisms by which steroid molecules might act to improve recovery after traumatic brain injury are numerous.
The effects of steroid administration on the central nervous system are not uniform but depend on the population of neurons studied. Definite deleterious effects of steroid administration on neuronal survival have been described.
This review discusses why glucocorticoids might be effective, the considerable laboratory evidence supporting the use of 21-aminosteroids, and the potentially harmful effects of steroid molecules on the brain.
尽管进行了25年的随机对照试验，但给予创伤性脑损伤患者类固醇的益处仍未得到证实。传统上，糖皮质激素一直被经验性地用于减轻炎症和水肿。然而，越来越明显的是，类固醇分子可能通过多种机制来促进创伤性脑损伤后的恢复。
给予类固醇对中枢神经系统的影响并不一致，而是取决于所研究的神经元群体。已经描述了给予类固醇对神经元存活具有明确的有害影响。
本综述讨论了糖皮质激素可能有效的原因、支持使用21-氨基类固醇的大量实验室证据，以及类固醇分子对大脑的潜在有害影响。
