机械通气近足月儿血清皮质醇水平的变化

目的 通过监测不同日龄近足月儿血清皮质醇水平,观察机械通气时近足月儿下丘脑-垂体-肾上腺轴(HPAhypothalamus- putit uary-adrenal)分泌皮质醇水平的变化,探讨其变化规律.方法 研究对象为入院时日龄在生后72 h内,胎龄34～36周(239～259 d)的住院近足月儿63例,其中机械通气组患儿33例,对照组30例.对照组为胎龄≥34周无需机械通气,新生儿危重症评分大于90分的近足月儿.全部患儿分别在入院时、日龄7d、14d时采血检测血清皮质醇水平.结果 (1)机械通气组患儿血清皮质醇浓度随日龄增大呈逐渐上升趋势,而对照组血清皮质醇浓度呈逐渐下降趋势;(2)日龄14d时机械通气组患儿血清皮质醇浓度显著高于对照组(t=-3.898,P=0.000).结论 机械通气近足月儿HPA轴已具备一定应激的能力,且生后随着日龄增长,发育的成熟,HPA轴能够适当调整及恢复,从而促进血清皮质醇进一步的合成及分泌增加.

Changes of cortisoi in near full term infants with mechanical ventilation

Objective To investigate the effect of mechanical ventilation on near full term infanfs hypothalamus puti- tuary adrenal（HPA） axis,we measured the serum concentration of cortisol. Methods 63 near full-term infants who were transferred to our hospital within 72 hours after birth were involved. These infants were divided into two groups：mechanical ventilation group and control group. The control group, whose neonatal critical illness score （NCIS） were higher than 90. We measured their serum cortisol at the time of admission,day 7 and day 14 after birth. Results （ 1）The serum cortisol concentration on mechanical ventilation group infants was increased, while on the control group infants was decreased. （2）The serum cortisol concentration on mechanical ventilation group infants was significantly higher than that on control group infants on the day 14 after birth（ t= -3. 898, P= 0. 000 ）. Conclu- sions The near full term infant already has the ability to response stimuli by regulating cortisol secretion. The venti- lation infants＂ serum cortisol concentration can be increased. The greater the gestational age is,the more mature this ability is.