危重病患者全身应激对机体内环境的影响

目的 :探讨危重病患者应激状态下内环境的变化规律、代谢支持选择的最佳时机。方法 :12 7例因各种原因所致的全身炎症反应综合征 (SIRS)和多器官功能障碍综合征 (MODS) ,ICU危重病患者入院后 1、3、5、7、14日进行电解质、血糖、晶体渗透压监测 ,入院后第 2、5、10日检测血皮质醇。 38例接受重组人生长激素治疗。结果 :死亡组 (35例 )患者入院时表现为高钠血症和晶体渗透压升高 ,而存活组 (92例 )入院时出现低钠血症和晶体渗透压偏低 (P均 <0 .0 0 1)。死亡组患者血糖一直维持于较高水平 ,对胰岛素存在一定的耐受性 ;存活组患者治疗后血糖和胰岛素用量进行性下降 (P均 <0 .0 1)。生长激素能明显提高 2组患者血糖水平 (P均 <0 .0 1) ,增加危重病患者内环境紊乱。死亡组患者血皮质醇浓度一直处于较高水平 ,而存活组呈进行性下降至生理范围 (P<0 .0 1)。结论 :危重病患者应激反应可使内环境紊乱 ,这种紊乱与血皮质醇浓度及疾病的严重程度变化一致。血糖可作为危重症患者应激反应过程的一个监测指标。

Effects of stress response on internal environment in critically ill patients

Objective:To study the trend of variance of internal environment during stress response in critically ill patients.Methods:One hundred and twentyseven critically ill patients in ICU who suffered from systemic inflammatory response syndrom(SIRS) and muttiple organ dysfunction syndrome(MODS),were enrolled in this study and divided into two groups:survival group ( n= 92) and dead group ( n= 35).Serum electrolytes, glucose,and crystal osmotic pressure were monitored after hospitalization on 1,3,5,7,and 14 days. The level of serum corticosteroid was assayed 2,5,10 days after the hospitalization.Effect of human growth hormone on the level of serum glucose was also observed in those critically ill patients.Results: Hypernatremia and high crystal osmotic pressure were observed in nonsurvivors,whereas hyponatremia and low crystal osmotic pressure were found in survival group (both P <0 001).The serum glucose in dead group was maintained in high level and glucose in those patients was not sensitive to insulin,whereas serum glucose in survival group dropped progressively and the amount of insulin used in those patients was also decreased consequently (all P <0 01).Human growth hormone obviously increased the level of serum glucose and aggravated the disorder of internal environment in both groups.The level of serum corticosteroid was higher in dead group and decreased to normal scale gradually in survival group ( P <0 01).Conclusions:Stress response could result in disturbance of internal environment,which coincided with the level of serum corticosteroid and seriousness of patients.In addition,serum glucose can be used as a marker for severity of stress response in critical illness.