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目的：研究颅脑创伤（ TBI）患者急诊手术前后血清中的皮质醇（ COR）、类固醇结合球蛋白（ CBG）以及游离皮质醇（ FC）的变化，了解TBI急诊手术对血清COR的影响。方法随机选取TBI后保守治疗者29例（保守组）及接受急诊手术者26例（手术组），测定血清COR及CBG水平，通过COR及CBG计算获得FC，观察TBI后保守组与手术组以及手术组术前术后COR的变化。结果在急性TBI后，手术组术前COR水平高于保守组（ P＜0．05）；手术组术后COR水平下降（P＜0．05）；经过治疗后，手术组与保守组COR水平相当（P＞0．05）。 FC在各种情况下比较差异均无统计学意义（P＞0．05）。结论在急性TBI后，急诊手术可减轻应激反应，有利于神经内分泌的稳定。具有生物活性的FC在术前术后保持相对稳定。“,”Objective To investigate the alterations of serum cortisol (COR), corticosteroid-binding-globulin (CBG) and free cortisol (FC) after acute traumatic brain injury (TBI) emergency operation, and to find out the influence of emergency craniotomy to COR.Methods All patients were randomly selected, 29 of which were treated conservative-ly (conservative group) and 26 were treated surgically (surgical group).COR and CBG were measured; FC was calculated from COR and CBG.COR levels were compared between conservative and surgical groups, and between pre-operation and postoperation in surgical group.Results After acute TBI, the preoperation COR level in surgical group was higher than that in conservative group (P0.05).Conclusion Following acute TBI, emergency operation can alleviate stress reaction to keep the stability of neuroendocrine.Bio-active FC preserves relatively stable in perioperative period to maintain nor-mal physiological function.