Walker Mark L, Owen Phillip S, Sampson Candace, Marshall Janene, Pounds Teresa, Henderson Vernon J
Department of Surgery, Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia, USA.
Am Surg. 2011 May;77(5):579-85.
The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline cortisol levels (mean 56 ± 84 vs. 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs. 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.
创伤中与危重病相关的皮质类固醇功能不全（CIRCI）的范围尚未完全明确。本研究描述了我们对接受氢化可的松治疗的CIRCI创伤患者的经验。我们从一家二级创伤中心进行了为期5年的回顾性分析，采用肾上腺功能不全的生化和临床标准。70名患者符合CIRCI的纳入标准。尽管进行了治疗，死亡率仍为34%。非幸存者年龄较大，入院时基础亏空较大，脓毒症、菌血症和肺炎的发生率较高。与幸存者（平均30±22天；P = 0.029）相比，非幸存者的通气天数延长（平均53±64天）。肾脏替代治疗是死亡率的有力预测指标。与非脊髓损伤组相比，脊髓损伤患者的损伤严重程度评分较高（平均34±18），基线皮质醇水平升高（平均56±84对18±14；P = 0.004），并且需要更长时间的类固醇治疗（30±52对15±15天；P = 0.080）。我们的数据表明，即使患者得到适当治疗，创伤中的CIRCI仍与显著的死亡率和发病率相关。
