5-江荣才-脑损伤与糖皮质激素.pptVIP

患者机械通气可能性的比较 * * * * * In conclusion: * In conclusion: * In conclusion: * In conclusion: * * A double-edged sword Two-way effects of GCs after Neurotrauma GCs Physiological dose Short time usage Prolonged usage High dose Mortality Apoptosis Cognitive deficits PURPOSE TIME DOSAGE THERAPY SIDE EFFECTS NOTES Brain Edema 8hr High-dose Lessen peri-injury area edema Aggravate HPA injury, Sec. stress insuffi., and cognition deficits Benefit only penumbra edema, Reducing intracranial pressure is limited???far less than that of hypertonic dehydration drug Prim. HT injury 2-7d Moderate-dose Suppl. early GCs insuffi Peptic Ulcer (long-term usage) According to the existence of complications, injury severity, and adjust the dosage of GCs Sec. HPA injury 3-14d Optimum Supple. Stress Insuffi. Hyperglycemia and immunity compromise Adjust the GCs treatment according to the type and ??strength of stress stimulation (such as lung infection, gastrointestinal bleeding, etc.) Sec. Hypopituitism 14d Low-dose GCs replacement Overdose leads to water-sodium retention Adjust dosage of GCs according to the level of serum GCs. Spinal Cord Edema 8hr High-dose Lessen peri-injury area edema Aggravate apoptosis in peri-injury area. Significantly improve local compression of the spinal cord by edema reduction TBI后的GCs补充要点 TBI早期，避免高剂量GCs 部分TBI患者长期血清低GCs，需早作评价和尽早补充. 检查HPA轴功能很重要，如果确定HPA轴损伤，需要给予适量GCs补充. TBI晚期，需要评价HPA轴功能，如果需要，还需及时补充GCs. TBI后的其他激素的异常 25%–80%发生中枢性性腺功能低下 2%–15甲状腺功能低下 50%高泌乳素 18%生长激素低下 13%低皮质醇 mTBI和sTBI TBI后的其他激素的异常 45例sTBI 早晨1~4天 08-10am cortisol,GH, PRL, IGF-1, TSH, fT3, fT4, FSH, LH,T and SHBG(men).下午1~4天 17-19pm cortisol, GH Olivecrona Z1, Dahlqvist P, Koskinen LO.Acute neuro-endocrine profile and prediction of outcome after severe brain injury.Scand J Trauma Resusc Emerg Med. 2013 ,21:33. TBI后的其他激素的异常 结论：sTBI1~4天垂体轴相关激素明显代谢异常。大部分患者Cortisol低于临界低限值，提示肾上腺分泌不足，但却与患者预后差无相关关系。早期垂体-性腺轴的强抑制与患者预后较好相关。长时间抑制甲状腺功能则导致高死亡率和预后功能不良。该研究结果还待进一步评估 TBI后的内分泌异常需要加强研究 TBI后GCs分泌异常，它与垂体下丘脑其他激素如T3、