Collins J V, Clark T J, Brown D, Townsend J
Q J Med. 1975 Apr;44(174):259-73.
A study of 23 patients admitted to hospital with severe acute asthma is reported in which plasma cortisol level on admission was significantly correlated with the degree of acidaemia and pulse rate. Patients who had not previously received treatment with corticosteroids responded satisfactorily to repeated daily injections of tetracosactrin depot, the rate of improvement being comparable to that observed in other patients treated with intravenous hydrocortisone hemisuccinate. A prompt and sustained rise in plasma cortisol was also seen following tetracosactrin. The total daily dose of hydrocortisone required to achieve plasma cortisol levels above 100 mug/100 ml was less when given by continuous intravenous infusion compared with intermittent injections, and a regime of 3 mg/kg body weight every six hours by infusion appeared satisfactory. Most patients reported subjective improvement by about four hours after starting treatment but objective evidence did not appear until about six hours from the start. Measurements of FEV1 and FVC proved to be the most reliable indices of the beginning of improvement although pulse rate was the first index to show maximum improvement. Previous maintenance treatment with corticosteroids in patients with asthma did not appear materially to affect the plasma half-life of intravenous hydrocortisone (4 mgm/kg body weight) when compared with healthy subjects or other patients with asthma who had not previously been treated with corticosteroids.
本文报告了一项针对23例因严重急性哮喘入院患者的研究，结果显示入院时血浆皮质醇水平与酸血症程度及脉搏率显著相关。此前未接受过皮质类固醇治疗的患者对每日重复注射长效二十四肽促皮质素反应良好，改善速度与其他接受静脉注射半琥珀酸氢化可的松治疗的患者相当。注射二十四肽促皮质素后，血浆皮质醇也迅速且持续升高。与间歇性注射相比，持续静脉输注氢化可的松以达到血浆皮质醇水平高于100μg/100ml所需的每日总剂量更少，每6小时输注3mg/kg体重的方案似乎效果良好。大多数患者在开始治疗约4小时后报告主观症状有所改善，但客观证据直到开始治疗约6小时后才出现。尽管脉搏率是显示最大改善的首个指标，但FEV1和FVC测量结果被证明是改善开始的最可靠指标。与健康受试者或其他此前未接受过皮质类固醇治疗的哮喘患者相比，哮喘患者此前接受的皮质类固醇维持治疗似乎并未实质性影响静脉注射氢化可的松（4mg/kg体重）的血浆半衰期。
