糖皮質素在內科急症的角色

The Role of Glucocorticoid in Medical Emergency

徐嘉宏(Chia-Hung Hsu) ； 徐維信(Wei-Hsin Hsu) ； 吳達仁(Ta-Jen Wu)

《內科學誌》 22卷6期 (2011/12) Pp. 409-415

https://doi.org/10.6314/JIMT.2011.22(6).04

摘要

The physiological functions of adrenal corticoids include helping to maintain blood pressure and cardiovascular function, modulating immune inflammatory response, and regulating metabolism of protein, carbohydrate, and fat. Glucocorticoids are used in autoimmune disease, adrenal insufficiency, allergies, anaphylaxis, and organ transplantation. Glucocorticoids also play an important role in acute illness.Adrenal crisis is a life-threatening critical condition. Once the diagnosis is suspected, treatment with large volumes of glucose/ saline solution and glucocorticoid should be initiated immediately. Hydrocortisone 200-300 mg can be given on the first day, if necessary, together with 50 μg of fludrocortisone. The dose can be gradually reduced thereafter, and then changed to oral forms.Septic shock is the most commonly associated with critical-illness-related corticosteroid insufficiency (CIRCI).But although the diagnostic criteria for CIRCI is still not well established, there is some consensus on glucocorticoid therapy for critical illness. Early and continuous use of glucocorticoid is an effective adjuvant therapy for acute respiratory distress syndrome (ARDS). Monitoring the side effects of glucocorticoid and preventing the rebound of inflammation are important factors for a successful therapy.American College of Critical Care Medicine consensus statement (2008) recommended that (1) Hydrocortisone in a dose of 200 mg/ day in four divided doses or as a continuous infusion in a dose of 240 mg/day (10 mg/hr) for greater than 7 days is recommended for septic shock. (2) Methylprednisolone in a dose of 1 mg/kg/day for greater than 14 days is recommended in patients with severe early ARDS. (3) Dexamethasone is not recommended for the treatment of CIRCI. (J Intern Med Taiwan 2011; 22: 409-415)

關鍵字

糖皮質素 ； 皮質醇 ； 腎上腺危象 ； 重大疾病相關的皮質功能不全 ； 敗血性休克 ； 急性呼吸窘迫症

並列摘要

The physiological functions of adrenal corticoids include helping to maintain blood pressure and cardiovascular function, modulating immune inflammatory response, and regulating metabolism of protein, carbohydrate, and fat. Glucocorticoids are used in autoimmune disease, adrenal insufficiency, allergies, anaphylaxis, and organ transplantation. Glucocorticoids also play an important role in acute illness.Adrenal crisis is a life-threatening critical condition. Once the diagnosis is suspected, treatment with large volumes of glucose/ saline solution and glucocorticoid should be initiated immediately. Hydrocortisone 200-300 mg can be given on the first day, if necessary, together with 50 μg of fludrocortisone. The dose can be gradually reduced thereafter, and then changed to oral forms.Septic shock is the most commonly associated with critical-illness-related corticosteroid insufficiency (CIRCI).But although the diagnostic criteria for CIRCI is still not well established, there is some consensus on glucocorticoid therapy for critical illness. Early and continuous use of glucocorticoid is an effective adjuvant therapy for acute respiratory distress syndrome (ARDS). Monitoring the side effects of glucocorticoid and preventing the rebound of inflammation are important factors for a successful therapy.American College of Critical Care Medicine consensus statement (2008) recommended that (1) Hydrocortisone in a dose of 200 mg/ day in four divided doses or as a continuous infusion in a dose of 240 mg/day (10 mg/hr) for greater than 7 days is recommended for septic shock. (2) Methylprednisolone in a dose of 1 mg/kg/day for greater than 14 days is recommended in patients with severe early ARDS. (3) Dexamethasone is not recommended for the treatment of CIRCI. (J Intern Med Taiwan 2011; 22: 409-415)

並列關鍵字

Glucocorticoid ； Cortisol ； Adrenal crisis ； CIRCI, Critical-illness-related corticosteroid insufficiency ； Septic shock ； ARDS