On the diagnosis and treatment of critically ill elderly patients of adrenal insufficiency.docVIP

 PAGE \* MERGEFORMAT 11 On the diagnosis and treatment of critically ill elderly patients of adrenal insufficiency [Abstract] Objective To critically ill elderly patients with post-surgical adrenal insufficiency diagnosis and treatment, explore the pathophysiological mechanisms and their relationship with the condition and prognosis. Methods forward-looking choice in March 2005 ~ August 2008 received postoperative hospital stay of surgical ICU critically ill patients aged 56 cases. All patients were volume resuscitation and vasoactive drugs, if the mean arterial blood pressure lt;65 mmHg, give hydrocortisone 200 ~ 300 mg / d min intravenous drip into treatment, and is divided into hydrocortisone treatment group and non-treatment group. Results 56 patients 25 patients (44.6%) received physiological doses of hydrocortisone replacement therapy, in which the treatment group of 19 patients (76.0 %) to 24 h after hydrocortisone treatment step can be disabled within the drug. Hormone replacement therapy and non-treatment group, functional adrenal insufficiency (FH) sub-group, treatment group significantly improved the success rate of withdrawal (P lt;0.05); adrenal dysfunction (AD) subgroup of patients is no exception, but because of small sample size, no statistically significant .56 cases of 16 patients died, mortality was 28.5%; adrenal insufficiency (AI) in the mortality rate in patients was 26.7% (8 / 30), treatment group mortality was 8% (2 / 25), significantly higher than non-treatment group 19.4% (6 / 31) and low (P lt;0.01). Conclusion elderly critically ill after surgery patients, early diagnosis of AI, timely and hormone replacement therapy can help reduce high-dose step-up drug use, improve patient survival. [Keywords:] adrenal dysfunction (AD); functional adrenal insufficiency (FH); adrenal insufficiency (AI); surgical patients; old; critical illness Adrenal insufficiency (AI) in the general population incidence is relatively low, less than the t