Objective To investigate the changes of serum cortisol, adrenocorticotrophic hormone (ACTH) and glucose in patients with severe traumatic brain injury (TBI) and its significance in injury evaluation and prognosis. Methods A total of 56 cases of severe TBI and 23 healthy cases were included in the study. All the severe TBI cases were divided into severe group ( GCS 3 ~ 5 group) and very severe group (GCS 6 ~ 8 group) according to their GCS. After 4 months'treatment, GOS was compared and the serum cortisol, ACTH and glucose were detected. Results Serum cortisol, ACTH and glucose in GCS 3 ~ 5 group and GCS 6-8 group were significantly increased compared to the control group in the first five days of hospitalization ( P < 0.01). Serum cortisol, ACTH and glucose in GCS 3-5 group were much higher than those in GCS 6 ~8 group (P<0.05). The mortality of GCS 3-5 group was significantly higher than that of GCS 6-8 group. Serum cortisol, ACTH and glucose in the TBI group were markedly higher than those in the control group in the first day. Conclusion Serum cortisol, ACTH and glucose are increased following TBI. The levels of serum cortisol, ACTH and glucose can be regarded as indices in evaluation of the severity, treatment efficacy and prognosis of TBI.%目的 评估重型颅脑创伤患者伤后不同时期的血清皮质醇(COR)、促肾上腺皮质激素(ACTH)及血糖水平的变化,及其在伤情判断与预后中的作用.方法 前瞻性选择重型颅脑创伤患者56例,正常对照组23例,重型颅脑创伤患者按入院时GCS评分分为重型组(6～8分)、特重型组(3～5分)两个亚组,治疗4个月后对比预后评分(GOS评分),测定不同时期血清COR、ACTH及血糖浓度.结果 GCS 3 ～5分与6～8分组血清COR、ACTH及血糖浓度入院后5d内均显著增高,与对照组比较差异有显著性(P＜0.01),GCS3～5分组血清COR、ACTH、血糖浓度高于GCS 6～8分组(P＜0.05).GCS 3 ～5分组死亡率明显高于6～8分组,颅脑损伤组第1d血清COR、ACTH、血糖浓度均显著高于对照组(P＜0.01).结论 重型颅脑创伤患者伤后血清COR、ACTH及血糖均有不同程度的增高,监测血清COR、ACTH及血糖浓度可作为判断患者病情轻重、治疗效果和预后的一项重要指标.
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