Monitoring The Changes Of Serum ACTH, COR And Glucose In Patients With Acute Craniocerebral Injury And Its Clinical Significance

Objective:In order to ivestigate the changes of serum adrenocorticotrophic hormone (ACTH), cortisol and glucose in patients with acute craniocerebral injury and to have a preliminary understanding of its significance in injury evaluation, guiding the clinical treatment and evaluating the prognosis.Methods:A total of88patients with acute craniocerebral injury (except those who suffer from diabetes) were divided into moderate craniocerebral injury group (GCS9^12group)、severe craniocerebral injury group (GCS6-8group) and very severe craniocerebral injury group (GCS3-5group) according to their GCS; then combined with the acute craniocerebral injury patients’ image data (head CT) and vital signs, divided all the severe and very severe acute craniocerebral injury cases (GCS3-8group) into cerebral hernia group and non cerebral hernia group according to whether or not brain herniation occurred.Another30people conducted health examination were recruited as normal control group.The serum ACTH, cortisol and glucose of patients with acute craniocerebral injury were detected and compared at the same time in different period after the injury, and then do some comparison analysis about them.Results:After the acute craniocerebral injury, serum ACTH,cortisol and glucose of patients with acute craniocerebral injury in the severe craniocerebral injury group (GCS6-8group) and very severe craniocerebral injury group (GCS3-5group) were increased rapidly and reached the peak at24h after the injury,then decreased gradually; and in the first3days after the injury, severe, very severe craniocerebral injury patients’ serum ACTH, COR and glucose were higher than that in the normal control group, there were significant differences between them(P<0.01).The changes of serum ACTH, cortisol and glucose in the moderate craniocerebral injury group (GCS9-12group) had no obvious regularity, its difference with the normal control group had no statistical significance (P>0.05). Serum ACTH,cortisol and glucose in very severe craniocerebral injury group (GCS3-5group) were much higher than that in severe craniocerebral injury group (GCS6-8group) in the first24hours after the injury (P<0.05). Serum ACTH,cortisol and glucose in cerebral hernia group were obviously higher than that in the non cerebral hernia group in the first3days after the injury (P<0.01).The disability rate and mortality of patients with high level of serum ACTH,cortisol and glucose in the first24h after the injury was markedly taller than those with lower level of serum ACTH,cortisol and glucose.Conclusion:Serum ACTH,cortisol and glucose are increased in different degrees and reached a peak at24h following severe or very severe acute craniocerebral injury,then decreased at different rates,and they are increased most obviously in the first5days after the injury.Serum ACTH, cortisol and glucose may have some increase, also may have no obvious change following moderate craniocerebral injury.In the acute phase of craniocerebral injury, serum ACTH, cortisol and glucose concentration of patients with brain hernia are significantly higher than patients without brain hernia.The disability rate and mortality of patients with much high level of serum ACTH,cortisol and glucose is markedly higher than those with a little high or normal level of serum ACTH, cortisol and glucose after the injury.Therefore,monitoring the changes of serum ACTH, cortisol and glucose of patients with acute craniocerebral injury is very important.The levels of serum ACTH, cortisol and glucose of patients with acute craniocerebral injury can provide an extremely important theoretical basis in judging the the severity of the injury, guiding related clinical treatments and evaluating the patients’prognosis.