Gross A Kendall, Winstead P Shane
UK HealthCare, Pharmacy Services, 800 Rose Street, Lexington, KY 40536-293, USA.
Orthopedics. 2009 Sep;32(9). doi: 10.3928/01477447-20090728-40.
The stress response, which is triggered by a number of factors, including surgery, results in activation of the hypothalamic pituitary adrenal axis and subsequent release of cortisol from the adrenal glands. Critical illness-related corticosteroid insufficiency is an inadequate corticosteroid response relative to a patient's illness; patients with critical illness-related corticosteroid insufficiency have both insufficient circulating cortisol and impaired cellular use of glucocorticoids. Corticosteroids, such as hydrocortisone, have been cited to improve survival, oxygenation, duration of mechanical ventilation, and intensive care unit-free days in critically ill patients. Perioperative glucocorticoid supplementation is also recommended in patients with secondary adrenal insufficiency due to chronic corticosteroid use.
应激反应由包括手术在内的多种因素触发，会导致下丘脑-垂体-肾上腺轴激活，随后肾上腺释放皮质醇。危重病相关皮质类固醇功能不全是指相对于患者病情而言皮质类固醇反应不足；患有危重病相关皮质类固醇功能不全的患者循环皮质醇不足且细胞对糖皮质激素的利用受损。诸如氢化可的松等皮质类固醇已被证明可提高重症患者的生存率、改善氧合、缩短机械通气时间并增加无重症监护病房天数。对于因长期使用皮质类固醇导致继发性肾上腺功能不全的患者，围手术期也建议补充糖皮质激素。
