Schelling Gustav, Roozendaal Benno, Krauseneck Till, Schmoelz Martin, DE Quervain Dominique, Briegel Josef
Ludwig-Maximilians-University, Klinikum Grosshadern, Department of Anaesthesiology, 81377 Muenchen, Germany.
Ann N Y Acad Sci. 2006 Jul;1071:46-53. doi: 10.1196/annals.1364.005.
Like other humans exposed to extreme trauma, patients who have been treated in an intensive care unit (ICU) often report traumatic memories. Extremely traumatic memories from the ICU in some of these patients are associated with the development of posttraumatic stress disorder (PTSD), which results in significant impairments in health-related quality of life (HRQL) outcomes of ICU therapy. Severely ill patients in the ICU often show insufficient endogenous glucocorticoid signaling, which has recently been termed critical illness-related corticosteroid insufficiency (CIRCI). We performed several controlled trials in ICU patients with suspected CIRCI from septic shock or cardiac surgery, which indicated that the administration of glucocorticoids (stress doses of hydrocortisone) during ICU treatment results in a significant reduction of PTSD symptoms in long-term survivors as well as improvements in HRQL outcomes. Stress doses of hydrocortisone could help to surmount impaired glucocorticoid signaling from CIRCI during critical illness resulting in a downregulation of the stress response as well as inhibition of traumatic memory retrieval and facilitated extinction of aversive information.
与其他遭受极端创伤的人一样，在重症监护病房（ICU）接受治疗的患者常常报告有创伤性记忆。这些患者中一些人在ICU的极端创伤性记忆与创伤后应激障碍（PTSD）的发生有关，这会导致ICU治疗的健康相关生活质量（HRQL）结果出现显著损害。ICU中的重症患者通常表现出内源性糖皮质激素信号不足，这一情况最近被称为危重病相关皮质类固醇功能不全（CIRCI）。我们对因感染性休克或心脏手术而疑似患有CIRCI的ICU患者进行了多项对照试验，结果表明，在ICU治疗期间给予糖皮质激素（应激剂量的氢化可的松）可显著降低长期幸存者的PTSD症状，并改善HRQL结果。应激剂量的氢化可的松有助于克服危重病期间CIRCI导致的糖皮质激素信号受损，从而下调应激反应，抑制创伤性记忆的恢复，并促进厌恶信息的消退。
