血清皮质醇水平及其动态监测与急性颅脑损伤严重程度及预后关系分析

摘要

目的 分析不同程度急性颅脑损伤患者血清皮质醇(COR)水平的动态监测特征及与预后关系.方法 80例急性颅脑损伤患者按入院时格拉斯哥昏迷(GCS)量表评分和颅脑CT表现判定颅脑损伤程度,并将其分为三组:轻型(n=28)、中型(n=30)、重型(n=22).于伤后1、2、3、7d及14d采集三组血清标本测定COR水平,并进行预后评估,以Pearson相关系数来评价血清COR水平与预后的关系.结果 轻型、中型、重型急性颅脑损伤患者伤后各时点血清COR水平依次明显升高,组间比较有显著性差异(P<0.05);且重型急性颅脑损伤患者伤后1、2、3、7d及14d血清COR水平波动幅度显著高于轻型、中型患者(P<0.05),三组伤后7、14d血清COR水平均呈正常趋势.轻型、中型、重型急性颅脑损伤患者ICU住院时间、机械通气时间及总住院时间依次明显延长,格拉斯哥预后评价量表(GOS)评分依次显著降低,组间比较有显著性差异(P<0.05);且三组预后情况分布差异有统计学意义(P<0.05),以重型急性颅脑损伤患者预后最差.急性颅脑损伤患者伤后14d血清COR水平与GOS评分呈负相关(P<0.05).结论 急性颅脑损伤患者血清COR水平明显升高,且损伤程度越严重COR水平升高越明显,动态监测变化幅度越大,且治疗期间COR水平变化与预后密切相关.%Objective To analyze the dynamic monitoring characteristics of serum cortisol(COR)levels in patients with acute craniocerebral injury of different severity and its relationship with prognosis.Methods 80 cases of acute craniocerebral injury patients were divided into three groups according to the traumatic degree of brain injury determined by the Glasgow Coma Scale score(GCS)and the brain CT manifestations after admission:the mild degree group(n=28),the moderate degree group(n=30)and the severe degree group(n=22).The COR levels were measured by the serum samples at 1d,2d,3d,7d and 14d after injury,and the prognosis was evaluated.Pearson correlation coefficient was used to evaluate the relationship between serum COR and prognosis.Results The levels of serum COR in the patients with mild,moderate and severe acute craniocerebral injury were increased successively,and there were significant differencesamong the groups(P<0.05).The changing degree of serum COR levels in the patients with severe acute craniocerebral injury were significantly higher than those in the patients with mild or moderate degree at 1d,2d,3d,7d and 14d after injury (P<0.05),and the serum levels of COR in the three groups were back to the normal levels at 7d and 14d after injury.The ICU hospital stays,mechanical ventilation time and total hospital stays were significantly prolonged successively in the patients with mild,moderate and severe acute craniocerebral injury while the score of the Glasgow Prognostic Rating Scale(GOS)was significantly decreased(P<0.05).The differences of prognosis were statistically significant among the three groups(P<0.05),and the prognosis of patients with severe acute craniocerebral injury was the worst.There was a negative correlation between serum COR level and GOS score in patients with acute craniocerebral injury at 14d after injury(P<0.05).Conclusion The level of serum COR increases significantly in patients with acute craniocerebral injury.and the more serious the injury iscorrelatedwith the higher the level of COR and the greater dynamic monitoring range.,The change of COR level during treatment is highly related to prognosis.