Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation
Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation
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DOI：
10.1007/s00134-004-2550-8
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发表时间：
2005-03-01
影响因子：
38.9
通讯作者：
Bollaert, PE
中科院分区：
文献类型：
--
作者：
Malerba, G;Romano-Girard, F;Bollaert, PE
目的：研究机械通气危重患者中相对肾上腺皮质功能缺乏的相关因素设计和设置：在一所大学附属教学医院的多学科ICU中进行的前瞻性观察研究患者：62名连续的需要机械通气超过24小时的急性病患者。测量和结果：气管插管后24小时进行高剂量短促肾上腺皮质激素试验。刺激后皮质醇升高低于90 μ g/l定义为相对肾上腺皮质功能不全（“无反应”患者组）。27名患者被归类为无应答者，35名患者被归类为应答者。在单变量分析中，无应答者更常为男性，平均动脉压较低，更常需要血管活性药物，肌酐清除率较低，SAPS II较高，器官功能障碍评分较高，并且比应答者更常接受依托咪酯单次推注气管插管。在多变量分析中，只有依托咪酯给药与相对肾上腺皮质功能缺陷相关（OR 12.21; 95% CI 2.99-49.74），而女性性别具有保护作用（OR 0.13; 95% CI 0.03-0.57）。结论：依托咪酯单次推注可能是ICU患者在给药后至少24小时内发生相对肾上腺皮质功能不全的主要风险因素。女性是一个独立的保护因素。
Objective: To study the factors associated with relative adrenocortical deficiency in mechanically ventilated, critically ill patients Design and setting: Prospective observational study in a multidisciplinary ICU of a university-affiliated teaching hospital Patients: Sixty-two consecutive, acutely ill patients needing mechanical ventilation for more than 24 h. Measurements and results: A high-dose short corticotropin test 24 h after endotracheal intubation. Relative adrenocortical deficiency ("nonresponder" group of patients) was defined by a rise in cortisol less than 90 mug/l after stimulation. Twenty-seven patients were classified as nonresponders and 35 as responders. On univariate analysis nonresponders were more often men, had lower mean arterial pressure, required vasoactive agents more often, had lower creatinine clearance, higher SAPS II, higher organ dysfunction scores, and received etomidate as a single bolus for endotracheal intubation more often than responders. On multivariate analysis, only etomidate administration was related to relative adrenocortical deficiency (OR 12.21; 95% CI 2.99-49.74) while female gender was protective (OR 0.13; 95% CI 0.03-0.57). Conclusions: A single bolus infusion of etomidate could be a major risk factor for the development of relative adrenocortical deficiency in ICU patients for at least 24 h after administration. Female gender is an independent protective factor.