【摘要】：目的對(duì)自發(fā)性腦出血患者不同時(shí)間點(diǎn)檢測(cè)血漿皮質(zhì)醇水平,了解其與疾病發(fā)展和預(yù)后的關(guān)系,為臨床治療提供理論依據(jù)。方法選擇自發(fā)性腦出血患者45例為研究對(duì)象,按GCS評(píng)分標(biāo)準(zhǔn)將患者分為輕-中型組和重-特重型組兩組,其中輕-中型組32例,重-特重型組13例。于發(fā)病后第1、3、7、10和14天分別抽取患者靜脈血連續(xù)測(cè)定皮質(zhì)醇(COR)、促腎上腺皮質(zhì)激素(ACTH)、總皮質(zhì)醇(TC)、皮質(zhì)醇結(jié)合球蛋白(CBG)含量,FC和FCI通過(guò)TC及CBG值計(jì)算得出。結(jié)果 (1)重-特重型組和輕-中型組患者血漿ACTH、COR在自發(fā)性腦出血第1、3、7、10和14天均有不同程度升高,在第1天內(nèi)達(dá)到高峰,然后隨著時(shí)間逐漸降低,兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05,P0.01);重-特重型組血漿COR和ACTH水平與輕-中型組相比時(shí)間越長(zhǎng)下降越明顯,COR和ACTH水平兩者之間具有良好的相關(guān)性。(2)發(fā)病后第1天TC、FC的FCI均顯著增高(P0.01),后逐漸下降;輕-中型組TC發(fā)病后第10天左右降到正常參考范圍,而重-特重型組還高于正常參考范圍。輕-中型組和重-特重型組中CBG于發(fā)病后第1天比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),后逐漸升高并有統(tǒng)計(jì)學(xué)意義(P0.01)。(3)兩組入院時(shí)GCS評(píng)分、Graeb評(píng)分、出血量比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);其中重-特重型組患者入院時(shí)GCS評(píng)分低于輕-中型組,Graeb評(píng)分和出血量高于輕-中型組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)兩組肺感染發(fā)生率、住院時(shí)間、出院3個(gè)月GOS評(píng)分比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);其中重-特重型組患者較輕-中型組住院時(shí)間延長(zhǎng),肺感染發(fā)生率升高,GOS評(píng)分降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 (1)血漿COR檢測(cè)可作為CT檢查必要有益的補(bǔ)充,TC、CBG、FC及FCI能夠作為評(píng)估患者病情及出血的可靠指標(biāo)。(2)自發(fā)性腦出血患者血漿皮質(zhì)醇含量呈現(xiàn)24 h內(nèi)升高達(dá)高峰,之后逐漸下降,在發(fā)病10 d左右降至正常水平的規(guī)律。發(fā)病后期出現(xiàn)的低皮質(zhì)醇含量變化直接影響到患者的預(yù)后,后期皮質(zhì)醇低于正常者其預(yù)后更差。(3)血漿COR水平的高低與患者發(fā)生肺感染有很密切的關(guān)系,同時(shí)也影響著患者的預(yù)后。
[Abstract]:Objective to detect plasma cortisol levels in patients with spontaneous cerebral hemorrhage at different time points and to understand the relationship between cortisol levels and disease development and prognosis, so as to provide theoretical basis for clinical treatment. Methods 45 patients with spontaneous cerebral hemorrhage were divided into two groups according to GCS score: mild to moderate group and severe to severe group, including 32 cases in mild to moderate group and 13 cases in severe group. On the 1st, 3rd, 7th, 10th and 14th day after onset, the contents of cortisol (COR), cortisol (TC), cortisol binding globulin (CBG) were measured in venous blood of patients, respectively. FC and FCI were calculated by TC and CBG values. Results (1) Plasma ACTH,COR in severe group and mild to moderate group increased at the 1st, 7th, 10th and 14th day of spontaneous cerebral hemorrhage, reached the peak within the first day, and then decreased gradually with time, and there was significant difference between the two groups (P0.05, P01). The plasma COR and ACTH levels in the severe group were significantly lower than those in the mild to moderate group, and there was a good correlation between the levels of COR and ACTH. (2) the FCI of TC,FC increased significantly on the first day after onset (P01), and then decreased gradually. The TC level in the mild to moderate group decreased to the normal reference range about the 10th day after onset, while that in the severe group was also higher than that in the normal reference range. There was no significant difference in CBG between mild to moderate group and severe to severe group on the first day after onset (P 0.05), but gradually increased and statistically significant (P 0.01). (3). There were significant differences in GCS score, Graeb score and blood loss between the two groups on admission (P 0.05). Among them, the GCS score of severe and severe group was lower than that of mild to moderate group, and the Graeb score and bleeding volume were higher than those of mild to medium group. The difference was statistically significant (P 0.05). (4). The incidence of lung infection, hospitalization time and GOS score at 3 months after discharge were significantly different between the two groups (P 0.05). Among them, the hospitalization time was prolonged, the incidence of lung infection was increased and the GOS score was decreased in the mild to moderate group, the difference was statistically significant (P 0.05). Conclusion (1) the detection of plasma COR can be used as a necessary supplement to CT, and TC,CBG,FC and FCI can be used as a reliable index to evaluate the condition and bleeding of patients. (2) the content of plasma cortisol in patients with spontaneous cerebral hemorrhage increased to the peak within 24 hours, then decreased gradually, and decreased to normal level about 10 days after onset. The changes of low cortisol content in the late stage of the disease directly affect the prognosis of the patients, and the prognosis of the patients with cortisol is lower than that of the normal group at the later stage. (3) the level of plasma COR is closely related to the occurrence of pulmonary infection, and also affects the prognosis of the patients.
【作者單位】： 揚(yáng)州市職業(yè)大學(xué)醫(yī)學(xué)院;蘇州大學(xué)附屬高郵市人民醫(yī)院神經(jīng)外科;蘇州大學(xué)附屬高郵市人民醫(yī)院檢驗(yàn)科;
【分類號(hào)】：R743.34

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