糖皮质激素能否预防创伤后应激障碍?

Can posttraumatic stress disorder be prevented with glucocorticoids?

作者信息

Schelling Gustav, Roozendaal Benno, De Quervain Dominique J-F

机构信息

Ludwig-Maximilians University, Klinikum Grosshadern, Department of Anaesthesiology, 81377 Muenchen, Germany.

出版信息

Ann N Y Acad Sci. 2004 Dec;1032:158-66. doi: 10.1196/annals.1314.013.

Abstract

Patients with critical illness who are treated in an intensive care unit (ICU) often report traumatic memories from ICU treatment, receive exogenously administered glucocorticoids for medical reasons, and have a relatively high incidence of chronic stress symptoms and posttraumatic stress disorder (PTSD) during follow-up. ICU therapy could therefore represent a useful model for investigating glucocorticoid effects on traumatic memories and PTSD development. Studies in long-term survivors of ICU treatment demonstrated a clear and vivid recall of different categories of traumatic memory such as nightmares, anxiety, respiratory distress, or pain. The incidence and intensity of PTSD symptoms increased with the number of categories of traumatic memory present. The prolonged administration of glucocorticoids (stress doses of hydrocortisone) to critically ill patients resulted in a significant reduction of PTSD symptoms measured after recovery without influencing the number of categories of traumatic memory. This protective effect of cortisol can possibly be explained by a cortisol-induced temporary impairment in traumatic memory retrieval which has previously been demonstrated in both rats and humans. Therefore, stress doses of hydrocortisone could be useful for prophylaxis and treatment of PTSD.

摘要

在重症监护病房(ICU)接受治疗的重症患者经常报告ICU治疗带来的创伤性记忆,因医学原因接受外源性糖皮质激素治疗,且在随访期间慢性应激症状和创伤后应激障碍(PTSD)的发生率相对较高。因此,ICU治疗可能是研究糖皮质激素对创伤性记忆和PTSD发展影响的有用模型。对ICU治疗长期幸存者的研究表明,他们能清晰、生动地回忆起不同类型的创伤性记忆,如噩梦、焦虑、呼吸窘迫或疼痛。PTSD症状的发生率和严重程度随着存在的创伤性记忆类型数量的增加而上升。对重症患者长期给予糖皮质激素(应激剂量的氢化可的松),可使康复后测量的PTSD症状显著减轻,且不影响创伤性记忆的类型数量。皮质醇的这种保护作用可能是由于皮质醇诱导的创伤性记忆提取暂时受损,这一点此前在大鼠和人类中均已得到证实。因此,应激剂量的氢化可的松可能对PTSD的预防和治疗有用。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索