糖皮质激素在炎症性肠病围手术期的应用

来源:岁月联盟 作者: 时间:2017-02-28
        总之,对于需要外科手术治疗的IBD患者来说,必需根据术前用药情况以及手术大小, 手术时间长短来设计预防性使用糖皮质激素的用药方案。估计应激反应持续的时间, 给予应激所需的剂量为度, 不宜过量。若手术顺利且无并发症, 血浆皮质醇浓度一般在术后24一48小时恢复正常。当发生术后并发症时,应激反应持续,这时候需要根据具体情况考虑连续使用糖皮质激素,以有效保护肾上腺功能,防治肾上腺危象的发生。
        6  结论
        糖皮质激素是炎症性肠病患者内科治疗的经典药物之一。在IBD围手术期合理使用糖皮质激素可以调节内源糖皮质激素的分泌不足以及糖皮质受体的暂时性功能低下,有效保护肾上腺功能,防止肾上腺危象的发生,并且可以减少术后并发症以及减轻全身炎症反应。但是由于激素负面作用太多,如何在保证治疗的情况下,把激素用量减少至最小、最低剂量,是我们努力的方向。
参 考 文 献
[1]Matricon J. Immunopathogenesis of inflammatory bowel disease. Med Sci. 2010; 26(4):405-410.
[2]Yao Z, DuBois DC, Almon RR, Jusko WJ. Pharmacokinetic/pharmacodynamic modeling of corticosterone suppression and lymphocytopenia by methylprednisolone in rats. J Pharm Sci. 2008; 97(7):2820-2832.
[3]Rogler G. Gastrointestinal and liver adverse effects of drugs used for treating IBD. Best Pract Res Clin Gastroenterol. 2010; 24(2):157-165.
[4]Lichtenstein GR, Abreu MT, Cohen R, et al., American Gastroenterological Association. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006;130:940–987.
[5]Sands BE. New therapies for the treatment of inflammatory bowel disease. Surg Clin North Am, 2006, 86:1045-1064.
[6]Kim JJ, Haller J. Glucocorticoid hyper- and hypofunction: stress effects on cognition and aggression. Ann N Y Acad Sci. 2007; 1113:291-303. 
[7]Younes M, Neffati F, Touzi M, Hassen-Zrour S, Fendri Y, Béjia I, Ben Amor A, Bergaoui N, Najjar MF. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Joint Bone Spine.2007;74(5):472-476. 
[8]Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids--new mechanisms for old drugs. N Engl J Med. 2005; 353:1711–1723.
[9]Barnes PJ. Corticosteroid effects on cell signalling. Eur Respir J. 2006; 27:413–426.
[10]Hanne Rintamki, Harri M Salo, Outi Vaarala, and Kaija-Leena Kolho. New means to monitor the effect of glucocorticoid therapy in children. World J Gastroenterol. 2010 March 7; 16(9): 1104–1109. 
[11]Yoon SK, Sung SK, Jeong JC,et al. Matrix metalloproteinase-3:a novel signaling proteinase from apoptotic neuronal cells that activates microglia. The Journal of Neuroscience, 2005, 25(14):3701-3711.
[12]周琎,杨坤兴,吕成余,等.围手术期应用糖皮质激素对胃癌患者术后康复的影响[J].江苏医药,2009,35(5):529-530.
[13]李天民.合理使用糖皮质激素[J].中国医药导报,2009;6(5):165-166.

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