Adrenal Insufficiency in Critically Ill Emergency Department Patients: A Taiwan Preliminary Study
作者:Shy-Shin Chang、Shiumn-Jen Liaw、Michael J. Bullard、Te-Fa Chiu、Jih-Chang Chen、How-Chin Liao
DOI:10.1111/j.1553-2712.2001.tb00202.x
日期:2001.7
Objective: Unrecognized adrenal insufficiency can have serious consequences in critically ill emergency department (ED) patients. This prospective pilot study of adrenal function in patients with severe illness was undertaken to determine the prevalence of adrenal dysfunction and any relation to prior herbal drug use. Methods: In a high‐volume urban tertiary care ED, adult patients with sepsis or acute myocardial infarction (AMI) were eligible for the study. Over a two‐month period, a convenience sample was enrolled by the authors on arrival to the ED. Inclusion criteria were systemic inflammatory response syndrome (SIRS) criteria plus evidence of at least one organ dysfunction or cardiac marker plus electrocardiogram‐proven AMI. Exclusion criteria included known corticosteroid use. Serum cortisol was measured on arrival and for those patients with a level of <15 μg/dL (<414 nmol/L), an adrenocorticotropic hormone (ACTH) stimulation test was performed. Results: Of the 30 enrolled patients, 23 (77%) were suffering from severe sepsis and the other seven (23%) had an AMI. Thirteen of the 30 patients (43%; 95% CI = 25% to 65%) had serum cortisol levels of <15 μg/dL, consistent with adrenal insufficiency, nine with severe sepsis and four with an AMI. Eight (62%; 95% CI = 32% to 86%) of the 13 patients with low cortisol levels reported using herbal medications, while only two (12%; 95% CI = 1% to 36%) of the 17 with normal cortisol levels reported taking herb drugs (p = 0.01). Only two (15%; 95% CI = 2% to 45%) of the patients with low cortisol levels failed their corticotropin stimulation test, suggestive of true adrenocortical insufficiency. Both reported using herbal preparations. Conclusions: These results indicate that adrenal dysfunction is common among a group of critically ill patients seen in this Taiwanese ED. Moreover, the use of herbal drugs was high in the patients with low serum cortisols. Further studies are required to both confirm these findings and clarify whether a number of herbal medications contain corticosteroids.
目标: 未被识别的肾上腺功能不全在危重急诊室(ED)患者中可能会导致严重后果。本文前瞻性试点研究严重疾病的患者的肾上腺功能,旨在确定肾上腺功能障碍的发病率及其与先前草药药物使用之间的任何关联。方法: 在一家高容量的城市三级护理急诊科,符合研究条件的患者是患有败血症或急性心肌梗死(AMI)的成年患者。在两个月期间,符合条件的患者在抵达急诊科时由研究者们 recruiting。纳入标准是全身性炎症反应综合征(SIRS)标准加上至少一个器官功能障碍或心脏标志物阳性,且心电图证实为AMI。排除标准包括已知的类固醇药物使用。在患者抵达时测量血清皮质醇水平,对于血清皮质醇水平小于15 μg/dL(小于414 nmol/L)的患者,进行了促肾上腺皮质激素(ACTH)刺激试验。结果: 在招募的30名患者中,23名(77%)患有严重败血症,另外7名(23%)患有AMI。30名患者中,13名(43%;95% CI = 25%至65%)的血清皮质醇水平小于15 μg/dL,与肾上腺功能不全一致,其中9名患有严重败血症,4名患有AMI。13名低皮质醇水平患者中,有8名(62%;95% CI = 32%至86%)报告使用过草药药物,而17名正常皮质醇水平患者中,只有2名(12%;95% CI = 1%至36%)报告使用过草药药物(p = 0.01)。在13名低皮质醇患者中,只有2名(15%;95% CI = 2%至45%)的促肾上腺皮质激素刺激试验失败,提示真正的肾上腺皮质功能不全。这2名患者都报告使用过草药制剂。结论: 这些结果显示,在本研究中的台湾急诊室患者中,肾上腺功能障碍在危重病患者中很常见。此外,低血清皮质醇患者的草药药物使用率较高。需要进一步的研究来证实这些发现,并阐明多种草药药物是否含有类固醇。