相对肾上腺功能不全与脓毒性休克

相对肾上腺功能不全是脓毒症的常见并发症,易发于脓毒症休克患者.下丘脑-垂体-肾上腺轴、医源性因素、血皮质醇结合球蛋白水平、糖皮质激素抵抗等与相对肾上腺功能不全的发病密切相关.关于脓毒性休克合并相对肾上腺功能不全,临床尚缺乏明确的诊断标准.目前,糖皮质激素被推荐用于对液体复苏及血管收缩药物反应不佳的危重患者.血皮质醇水平可作为评价脓毒性休克合并相对肾上腺功能不全患者预后的指标.

Relative adrenal insufficiency and septic shock

Relative adrenal insufficiency is a common complication in sepsis patients, with a higher morbidity in septic shock patients. Relative adrenal insufficiency is closely related to hypothalamic-pituitary-adrenal axis, iatrogenic factors, the level of corticosteroid-binding globulin in blood and steroid-resistance. At present the clinical diagnosis of adrenal insufficiency lacks definite criterion during septic shock. Current recommendations limit the use of corticosteroids to patients poorly responsive to fluid resuscitation and vasopressor therapy. The level of bood cortisol is an prognostic indicator in patients with septic-induced relative adrenal insufficiency.