The Relative Adrenal Insufficiency Of The Old Postoperative Critically Ill Patients

Objective To examine the incidence of relative adrenal insufficiency in the old postoperative critically ill patients and the relationship between the plasma concentrations of corticoid and the postoperative complications and mortality. At the same time, the change pattern of cortisol and aldosterone were observed.Methods 40 postoperative old patients above 65 years old directly hospitalized in ICU of the 1^st Affiliated Hospital of Kunming Medical College after operation from October 2005 to October 2006 were enrolled in this study. The patients whose APACHE II score was more than 8 were studied. Blood was drawn at 10:00 o' clock on the 1^st, 2^nd, and 5^th day to detect the plasma concentrations of the corticoid, aldosterone, natrium, potassium and sugar. Then the ACTH stimulation tests were carried out (according to the instruction of the ACTH produced by the First Biochemical Pharmaceuticals Company of Shanghai). At the same time, the detailed data of the enrolled patients, such as sex, age, diagnosis, prognosis, stay time in ICU and whether the hypotention complication happened were recorded. Plasma concentrations of cortisol of 40 patients for health examinations were detected as control group. Results 1. The basal total cortisol concentrations of the postoperative patients were higher than that of the control group (23.63±11.85)μg/dl vs. (19.3±4.5)μg/dl, P<0.05. 2. 47.5% of the postoperative old patients met the described criteria for RAI (total cortisol increment after ACTH stimulation test≤9μg/dl). 3. The mortality in the RAI group was 73.33%, comparing with 19.05% in the Non-RAI group, the difference was significant (x²=6. 42, P = 0. 011).4. The basical cortisol concentrations after operation were significantly related with the disease severity (r = 0. 351, P=0. 026).5. The concentrations of cortisol in both live and dead groups increased on the 1^st and 2^ndday after operation and decreased on the 5^th day. But the dead group changed more dramatically. The concentrations of aldosterone remained relative stable.Conclusions: 1.The incidence of RAI is high in the old postoperative patients. 2. The RAI increases the incidence of hepotension and the mortality in the old postoperative patients. 3. The basical concentrations of cortisol after operation were significantly related with the severity of disease.