Cooper Mark Stuart, Stewart Paul Michael
Department of Endocrinology, Division of Medical Sciences, Institute of Biomedical Research, The University of Birmingham, United Kingdom.
J Intensive Care Med. 2007 Nov-Dec;22(6):348-62. doi: 10.1177/0885066607307832.
One of the more controversial areas in critical care in recent decades relates to the issue of adrenal insufficiency and its treatment in critically ill patients. There is no consensus on which patients to test for adrenal insufficiency, which tests to use and how to interpret them, whether to use corticosteroids, and, if so, who to treat and with what dose. This review illustrates the complexity and diversity of pathophysiological changes in glucocorticoid secretion, metabolism, and action and how these are affected by various types of illness. It will review adrenal function testing and give guidance on corticosteroid replacement regimens based on current published literature. There remain inherent difficulties in interpreting the effects of glucocorticoid replacement during critical illness because of the diversity of effects of glucocorticoids on various tissues. Investigation and treatment will depend on whether the likely cause of corticosteroid insufficiency is adrenal or central in origin.
近几十年来，重症监护领域中争议较大的一个领域涉及肾上腺功能不全问题及其在重症患者中的治疗。对于哪些患者应进行肾上腺功能不全检测、使用何种检测方法以及如何解读检测结果、是否使用皮质类固醇激素，以及如果使用，哪些患者应接受治疗、使用何种剂量等问题，目前尚无共识。本综述阐述了糖皮质激素分泌、代谢及作用的病理生理变化的复杂性和多样性，以及这些变化如何受到各类疾病的影响。它将回顾肾上腺功能检测，并根据当前已发表的文献，对皮质类固醇激素替代治疗方案提供指导。由于糖皮质激素对不同组织的作用具有多样性，因此在解读重症期间糖皮质激素替代治疗的效果时，仍然存在内在困难。调查和治疗将取决于皮质类固醇激素不足的可能病因是肾上腺源性还是中枢源性。
