中枢性消化管出血とglucocorticoid

概要

論文の詳細を見る
Hypothalamo-hypophyseal adrenal function of patients with neurogenic gastrointestinal hemorrhage in neurosurgery cases were studied. Measurement of circadian cortisol rhythm and insulin tolerance test were performed for patients with severe brain damage who had developed gastrointestinal hemorrhage under glucocorticoid administration. The results showed : 1) circadian cortisol rhythm was abolished and cortisol levels were suppressed very easily by only 1 mg/day of Dexamethasone and they required two days to recover : and 2) endogenous cortisol response to hemorrhagic shock or hypoglycemia was completely suppressed by pharmacological doses of glucocorticoids (Dexamethasone 16-32 mg/day). Therefore, if glucocorticoid administration was discontinued completly in patients with gastrointestinal hemorrhage, they may fall into acute adrenal insufficiency, which could be dangerous. We have been using pharmacological doses of glucocorticoids every 6 hours intravenously and have succeeded in decreasing the incidences of neurogenic gastrointestinal hemorrhage to 5.5%. In conclusion, we propose that in cases of neurogenic gastrointestinal hemorrhage, pharmacological doses of glucocorticoids be provided every 6 hours.
日本脳神経外科学会の論文
1979-10-15