Brorsson Camilla, Dahlqvist Per, Nilsson Leif, Thunberg Johan, Sylvan Anders, Naredi Silvana
Department of Anaesthesia and Intensive Care, Institution of Surgery and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden.
Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden.
Injury. 2014 Aug;45(8):1149-55. doi: 10.1016/j.injury.2014.02.001. Epub 2014 Feb 17.
The adrenal response in critically ill patients, including trauma victims, has been debated over the last decade. The aim of this study was to assess the early adrenal response after trauma.
Prospective, observational study of 50 trauma patients admitted to a level-1-trauma centre. Serum and saliva cortisol were followed from the accident site up to five days after trauma. Corticosteroid binding globulin (CBG), dehydroepiandrosterone (DHEA) and sulphated dehydroepiandrosterone (DHEAS) were obtained twice during the first five days after trauma. The effect of time and associations between cortisol levels and; severity of trauma, infusion of sedative/analgesic drugs, cardiovascular dysfunction and other adrenocorticotropic hormone (ACTH) dependent hormones (DHEA/DHEAS) were studied.
There was a significant decrease over time in serum cortisol both during the initial 24 h, and from the 2nd to the 5th morning after trauma. A significant decrease over time was also observed in calculated free cortisol, DHEA, and DHEAS. No significant association was found between an injury severity score ≥ 16 (severe injury) and a low (< 200 nmol/L) serum cortisol at any time during the study period. The odds for a serum cortisol < 200 nmol/L was eight times higher in patients with continuous infusion of sedative/analgesic drugs compared to patients with no continuous infusion of sedative/analgesic drugs.
Total serum cortisol, calculated free cortisol, DHEA and DHEAS decreased significantly over time after trauma. Continuous infusion of sedative/analgesic drugs was independently associated with serum cortisol < 200 nmol/L.
在过去十年中，包括创伤患者在内的危重症患者的肾上腺反应一直存在争议。本研究的目的是评估创伤后的早期肾上腺反应。
对一家一级创伤中心收治的50例创伤患者进行前瞻性观察研究。从事故现场开始跟踪血清和唾液皮质醇，直至创伤后五天。在创伤后的头五天内两次测定皮质类固醇结合球蛋白（CBG）、脱氢表雄酮（DHEA）和硫酸脱氢表雄酮（DHEAS）。研究了时间的影响以及皮质醇水平与创伤严重程度、镇静/镇痛药物输注、心血管功能障碍和其他促肾上腺皮质激素（ACTH）依赖性激素（DHEA/DHEAS）之间的关联。
在最初的24小时内以及创伤后第二天至第五天早晨，血清皮质醇随时间显著下降。计算得出的游离皮质醇、DHEA和DHEAS也随时间显著下降。在研究期间的任何时间，损伤严重程度评分≥16（重伤）与低（<200 nmol/L）血清皮质醇之间均未发现显著关联。与未持续输注镇静/镇痛药物的患者相比，持续输注镇静/镇痛药物的患者血清皮质醇<200 nmol/L的几率高八倍。
创伤后总血清皮质醇、计算得出的游离皮质醇、DHEA和DHEAS随时间显著下降。持续输注镇静/镇痛药物与血清皮质醇<200 nmol/L独立相关。
