【摘要】 目的:探讨氢化可的松在后腹腔镜下治疗皮质醇增多症围手术期激素替代中的应用。方法:回顾性分析36例皮质醇增多症患者在后腹腔镜手术治疗围手术期采用静滴氢化可的松随后改为口服氢化可的松的激素替代方案:术中予静滴氢化可的松100 mg,术后当天、第1 d和第2 d分别静滴氢化可的松100 mg(1次/12 h)、100 mg(1次/12 h)和100 mg(1次/d),从第2 d开始口服氢化可的松片40 mg(3次/d),逐渐减量至20 mg开始维持治疗。术后密切观察临床症状,并间断监测血、24 h尿皮质醇变化来评价该激素替代治疗效果。结果:2例出现轻微皮质功能不全症状;6例血Co(r皮质醇)低于正常范围;血钾较术前明显升高(P<0.05);术后第1、2 d尿Cor明显升高(P<0.05);第7 d尿Cor明显降低(P<0.05);血Cor从第2 d开始较术前降低(P值均P<0.05)。结论:氢化可的松在腹腔镜治疗皮质醇增多症围手术期激素替代治疗中,是安全可行的。更多还原

【Abstract】 Objective To investigate the effect of application of hydrocortisone in hormone replacementtherapy during perioperation of Cushing’s syndrome after laparoscopic operation.Methods A retrospectiveanalysis about the data and outcome of 36 cases of Cushings’ s syndrome treated by intravenous dripping andoral hydrocortisone hormone replacement therapy during perioperation after laparoscopic surgery. One hundredmg hydrocortisone was given by intravenous injectionduring removal of adrenal adenoma,followed by 100mg given every 12 hours at the same day,then 100mg every 12hours on the first day and 100 mg daily on the second day after operation. Oral hydrocortisone 40mg was given three times daily on the second day,followed by a reduction of 20 mg daily until a maintenancedosage(20 mg) was reached. After laparoscopic surgery, the clinical symptoms were closely observed, and theblood and urine cortisol levels were intermittentty monitored to evaluate the therapeutic effect of the hormone replacement therapy.Results Two cases had slight cortical dysfunction symptoms; six patients had blood cortisol levels lower than those of the first and second days after surgery(P < 0.05); on the seventh day reduced significantly below the normal range; the serum potassium level of postoperation was significantly higher than thatof preoperation(p<0.05); the urinary cortisol level of postoperation was significantly higher(P < 0.05); the serum cortisol level began to reduce significantly on the second day after surgery(P < 0.05).Conclusion Theeffect of hydrocortisone in hormone replacement therapy during perioperation of Cushing’s syndrome after laparoscopic operation is safe and feasible.更多还原