Fuchs Paul Ch, Groger Andreas, Bozkurt Ahmet, Johnen Daniel, Wolter Timm, Pallua Norbert
Department for Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, Germany.
Shock. 2007 Dec;28(6):662-667.
Thermal injuries of more than 20% of body surface area lead to conditions resembling a severe systemic inflammatory response syndrome, such as in septic shock. It has been shown that septic shock may lead to disturbances in cortisol metabolism and balance of the hypothalamic-pituitary-adrenal axis. To investigate whether such a disturbance also occurs in the very early stages of systemic inflammatory response syndrome in burned patients, we performed 20 corticotropin-releasing hormone tests on day 1 after admission to our unit. In 7 of 20 patients, a disturbance of cortisol secretion could be demonstrated. Four patients developed adrenal insufficiency. The correlation between the abbreviated burn severity index and the risk of developing adrenal insufficiency was significant (P = 0.008). We observed a higher mortality rate in adrenally insufficient patients; however, because of the small patient number, we were not able to prove this observation with a statistical significant correlation (P = 0.11). Our findings indicate that temporary adrenal insufficiency occurs in the early stages of severe injury. Further investigations will have to be performed to clarify whether such patients benefit from cortisol replacement.
体表烧伤面积超过20%会导致类似严重全身炎症反应综合征的情况，如脓毒症休克。研究表明，脓毒症休克可能导致皮质醇代谢紊乱以及下丘脑 - 垂体 - 肾上腺轴失衡。为了研究这种紊乱是否也发生在烧伤患者全身炎症反应综合征的极早期，我们在患者入院第1天进行了20次促肾上腺皮质激素释放激素试验。20例患者中有7例可证明存在皮质醇分泌紊乱。4例患者出现肾上腺功能不全。简化烧伤严重程度指数与发生肾上腺功能不全风险之间的相关性显著（P = 0.008）。我们观察到肾上腺功能不全患者的死亡率较高；然而，由于患者数量较少，我们无法通过具有统计学意义的相关性来证实这一观察结果（P = 0.11）。我们的研究结果表明，严重损伤早期会出现暂时性肾上腺功能不全。还需要进一步研究以阐明此类患者是否能从皮质醇替代治疗中获益。
