危重病肾上腺功能障碍的研究进展

相对肾上腺皮质功能不全(RAI)在危重病患儿中具有较高的发生率.下丘脑-垂体-肾上腺轴的机械性损伤、炎症细胞因子或有毒代谢产物和激素抵抗是发生RAI的原因.脓毒症患儿出现儿茶酚胺抵抗的难治性休克或充分容量复苏前提下,血管活性药物反应不良时应高度警惕RAI.促肾上腺皮质激素(ACTH)刺激试验是判断RAI的主要方法,在标准剂量ACTH(250 μg)刺激试验的基础上,研究发现小剂量ACTH(1 μg)刺激试验可能具有高敏感性和安全有效等特点.

Recent approach of adrenal dysfunction in critical illness

There is high incidence of relative adrenal insufficiency (RAI) in critical children. The causes of adrenal insufficiency in patients with severe sepsis and septic shock are the mechanical injury of the hypothalamic-pituitary-adrenal axis, cytokines and other mediators of inflammatory or hormone resistance. There are many symptoms associated with adrenal insufficiency. Diagnosis is often suspected when these patients have hypotension refractory to fluid therapy and to vasoactive drugs. The corticotropin stimulation test is widely used as a method to identify adrenocortical hyporesponsiveness, but controversy exists as to the corticotropin dose to be used. The 250 μg dose is the standard dose. Low doses of corticotropin (1 μg) have recenfly been proposed,suggesting that they may have higher sensitivity and the characteristics of safe and effective.