Clinical Research On The Relationship Between The Plasma Cortisone And The Stress Digestive Tract Hemorrhage After Acute Severe Head Injury

Objective: To probe into the changes of human plasma cortisone after acute severe head injury (ASHI) (GCS <8) and its association with the stress ulcer (SU) so as to offer the theoretical basis on prevention of SU.Methods: The plasma cortisone was tested respectively in 68 patients with ASHI on admission (Cor.O), the 1st day(Cor.1), the second day (Cor.2), the 3rd day (Cor.3), the 5th day (Cor.5), the 7th day (Cor.7) and the 10th day (Cor.10) after injury. At the same time, it was recorded whether SU occurred or not. A six-month follow-up was performed and their prognoses were observed.(1)According to GCS grade, 68 patients were grouped as three. The patients whose score was 3 or 4 were classified into Group One, 5 or 6 into Group Two and 7 or 8 into Group Three. A t-test and a correlative analysis have been made between the Cor.O groups and the other groups.(2)The patients were divided into two groups - hemorrhage and non-hemorrhage according to whether SU happened. The difference of the plasma cortisone level between the Cor.O and the Cor.3 has been statistically analyzed with t-test.(3)The difference of GCS groups have been compared between the hemorrhage group and the non-hemorrhage group with Mann-Whitney Test.(4)The influence of the Cor.O and the age on SU were respectively analyzed with Logistic Regression method.(5)The differences of prognosis have been compared between the hemorrhage group and the non-hemorrhage group with Mann-Whitney Test.(6)The crosstabs has been used in order to analyze the effects of the usage of H₂ receptor antagonist in the prevention from SU.(7)We have made a graph with the mean of the plasma cortisone to observe the trend of the plasma level of cortisone changes after injury.Results:CDThe Cor.O had a negative correlation with the GCS.?The differences of plasma cortisone level of the Cor.O and the Cor.3 were significant between the hemorrhage group and the non-hemorrhage group.?The GCS grade was significantly different between the hemorrhage group and the non-hemorrhage group.?The probability of SU raised with the increase of Cor.O level and age.?The patients with SU had poorer prognoses than those without SU.?The incidences of SU between preventive usage of H2 receptor antagonist and not-usage of H2 receptor antagonist were not significantly different.?The level of the plasma cortisone increased rapidly and markedly after injury and lasted for about 3 days. Afterwards, it decreased slowly and became the normal at the 10th day.Conclusions:?It has important reference value in evaluating the state of illness and prognosisto dynamically investigating plasma cortisone level.?The Cor.O level and the advanced age were the risk factors of SU. (3)H2 receptor antagonist couldn't effectively prevent from SU in ASHI.