Relationship of stress hormone response in head-injured patients and survival.

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Except excessive catecholamine secretion, no significant clinical result has been proven on stress hormones in head-injured patients. We clarified initial stress hormone secretion and their correlation in head-injured patients on admission. All 27 head-injured patients--22 men and 5 women--studied were brought to our hospital directly by ambulance from the injury site. Blood samples were drawn through the central venous catheter or peripheral venous canula immediately on arrival before drug injection or infusion. Catecholamine, growth hormone (GH), adrenocorticotropic hormone (ACTH), antidiuretic hormone (ADH), and cortisol (CSL) in samples were measured and their correlation studied. Patients were divided into 4 groups based on intracranial hemorrhagic lesion and outcome at 1 month and hormone secretion compared. A significant positive correlation was seen between AD and GH (r=0.769, p<0.0001), ADH (r=0.911, p<0.0001), CSL (r=0.409, p<0.05). In non-survivors, AD was significantly higher than in survivors (p<0.05), and ACTH secretion significantly lower (p<0.05). The AD/ACTH ratio exceeded 9 in nonsurvivors and was 8 or less in survivors. Of stress hormones, GH, ADH, and CSL increased correlatively with AD, thought to be a sympathetic response to injury, but only ACTH decreased in initial blood samples. The AD/ACTH ratio may thus be predictive for the outcome in patients 1 month after injury.
一般社団法人日本救急医学会の論文