The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate.
The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate.
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DOI：
10.1186/cc4979
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Finkielman JD
中科院分区：
文献类型：
--
作者：
Mohammad Z;Afessa B;Finkielman JD
依托咪酯以连续输液或单次给药的形式静脉给药时，会阻断肾上腺皮质的合成。目前尚未正式研究依托咪酯对感染性休克患者相对肾上腺皮质功能不全发生率的影响。这项研究的目的是确定感染性休克患者服用依托咪酯后相对肾上腺皮质功能不全的发生率，并与未服用依托咪酯的感染性休克患者进行比较。在这项回顾性研究中，152名感染性休克患者在2002年3月至2003年8月期间在一家三级医学中心接受了促肾上腺皮质激素刺激试验。相对肾上腺功能不全被定义为给予250≤g康合托品后血清皮质醇μ9μg/dl升高。患者被分为在刺激试验前接受依托咪酯治疗的患者和没有接受依托咪酯治疗的患者。用Fischer‘s Exact检验比较两组中相对肾上腺功能不全患者的比例。P值<；0.05被认为具有统计学意义。患者平均年龄为，男性占59%，白人占97%，住院死亡率为57%。38例患者(25%)在进行促肾上腺皮质激素刺激试验前接受依托咪酯治疗，给药至试验的中位时间间隔为7(4-10)小时。接受依托咪酯治疗的患者相对肾上腺功能不全的发生率为76%，而未接受依托咪酯治疗的患者相对肾上腺功能不全的发生率为51%(P=0.0077)。感染性休克患者在给予依托咪酯后进行刺激试验时，相对肾上腺功能不全的发生率增加。
Etomidate blocks adrenocortical synthesis when it is administered intravenously as a continuous infusion or a single bolus. The influence of etomidate administration on the incidence of relative adrenal insufficiency in patients with septic shock has not been formally investigated. The objective of this study was to determine the incidence of relative adrenal insufficiency in patients with septic shock after etomidate administration compared with patients with septic shock who did not receive etomidate. In this retrospective study, 152 adults with septic shock who had a consyntropin stimulation test between March 2002 and August 2003 in a tertiary medical center were included. Relative adrenal insufficiency was defined as a rise in serum cortisol ≤ 9 μg/dl after the administration of 250 μg of consyntropin. Patients were divided into those who did and those who did not receive etomidate before the stimulation test. The proportion of patients with relative adrenal insufficiency in these two groups was compared using Fischer's exact test. A P of value < 0.05 was considered statistically significant. The mean age of the patients was 64 years, 59% of patients were male, 97% of patients were white and their hospital mortality rate was 57%. Thirty-eight patients (25%) received etomidate before the cosyntropin stimulation test, and the median (interquartile range) time interval between the administration of the drug and the test was 7 (4–10) hours. The incidence of relative adrenal insufficiency was 76% in the patients who received etomidate compared with 51% in the patients who did not (P = 0.0077). The incidence of relative adrenal insufficiency in patients with septic shock is increased when the stimulation test is performed after the administration of etomidate.
影响因子：
120.7
作者：
Annane, D;Sébille, V;Bellissant, E
通讯作者：
Bellissant, E
影响因子：
38.9
作者：
Malerba, G;Romano-Girard, F;Bollaert, PE
通讯作者：
Bollaert, PE
影响因子：
120.7
作者：
Annane, D;Sébille, V;Bellissant, E
通讯作者：
Bellissant, E