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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Diurnal salivary cortisol measurement in the neurosurgical-surgical intensive care unit in critically ill acute trauma patients
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Diurnal salivary cortisol measurement in the neurosurgical-surgical intensive care unit in critically ill acute trauma patients

机译：重症急性创伤患者神经外科重症监护病房的每日唾液皮质醇测量

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摘要

Acute trauma patients represent a specific subgroup of the critically ill population due to sudden and dramatic changes in homeostasis and consequently extreme demands on the activity of the hypothalamic-pituitary-adrenocortical (HPA) axis. Salivary cortisol is an accepted surrogate for serum free cortisol in the assessment of HPA axis function. The purpose of this study was (1) to establish the feasibility of salivary cortisol measurement in acute trauma patients in the neurosurgical-surgical intensive care unit (NSICU), and (2) to determine the diurnal pattern of salivary cortisol in the acute phase after injury. Saliva from 50 acute trauma patients was prospectively collected twice a day at 6AM and 4PM during the first week after injury in the NSICU. Mean PM cortisol concentrations were significantly higher in subjects versus controls (p < 0.001). Subjects failed to develop the expected PM versus AM decrease in cortisol concentration seen in controls (p = 0.005). Salivary cortisol did not vary significantly with baseline Glasgow Coma Scale (GCS), Injury Severity Score, sex, injury type, ethnicity, or age. When comparing mean AM and PM salivary cortisol by GCS severity category (GCS <= 8 and GCS >8) the AM salivary cortisol was significantly higher in patients with GCS <= 8 (p = 0.002). The results show a loss of diurnal cortisol variation in acute trauma patient in the NSICU during the first week of hospitalization. Patients with severe brain injury had higher morning cortisol levels than those with mild/moderate brain injury. (C) 2014 Elsevier Ltd. All rights reserved.
机译：由于动态平衡的突然和剧烈变化，因此对下丘脑-垂体-肾上腺皮质激素（HPA）轴的活动提出了极高的要求，急性创伤患者代表了重症患者的特定亚组。唾液皮质醇是评估HPA轴功能的血清游离皮质醇的公认替代品。这项研究的目的是（1）建立神经外科手术重症监护病房（NSICU）在急性创伤患者中唾液皮质醇测量的可行性，以及（2）确定术后急性期唾液皮质醇的昼夜模式受伤。在NSICU受伤后的第一周内，每天早上6点和下午4点收集两次来自50名急性创伤患者的唾液。受试者的平均PM皮质醇浓度显着高于对照组（p <0.001）。受试者未能在对照中观察到皮质醇浓度的预期PM与AM降低（p = 0.005）。唾液皮质醇与基线格拉斯哥昏迷量表（GCS），损伤严重度评分，性别，损伤类型，种族或年龄无显着差异。当按GCS严重程度类别（GCS <= 8和GCS> 8）比较AM和PM唾液皮质醇的平均值时，GCS <= 8的患者AM唾液皮质醇显着更高（p = 0.002）。结果显示，在住院的第一周内，NSICU的急性创伤患者的每日皮质醇变化消失。严重脑损伤的患者早晨皮质醇水平高于轻度/中度脑损伤的患者。 （C）2014 Elsevier Ltd.保留所有权利。

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