呼吸衰竭新生儿肾上腺皮质功能状态分析

目的 研究呼吸衰竭新生儿(新生儿呼吸窘迫综合征、肺炎和重症湿肺)肾上腺皮质功能变化、肾上腺皮质功能不全(AI)的发生率及其与病情的关系.方法 研究对象为人住我院的呼吸衰竭新生儿55例(其中早产儿33例,足月儿22例),分别检测清晨血清基础皮质醇和促肾上腺皮质激素(ACTH)浓度,及小剂量ACTH刺激试验30 min后血清皮质醇峰值.血清皮质醇峰值浓度＜200 μg/L为合并AI.结果 呼吸衰竭早产儿基础皮质醇浓度较足月儿高(139.2±85.4)μg/L vs(92.1±75.0)μg/L,P=0.040 7],而小剂量ACTH刺激试验前后皮质醇差值及ACTH浓度则较足月儿低(122.3±56.4)μg/L vs(198.2±77.9)μg/L,P=0.000 1;(5.22±2.40)ng/L vs(8.66±5.41)ng/L.P=0.008 4].呼吸衰竭新生儿合并AJ的发生率为20.0%(11/55),其中早产儿组为21.2%(7/33),足月儿组为18.2%(4/22).需机械通气呼吸衰竭新生儿AI的发生率(29.4%)高于非机械通气新生儿(4.8%).AI新生儿中无死亡病例.结论 呼吸衰竭早产儿肾上腺皮质和垂体功能较足月儿差.呼吸衰竭新生儿合并AJ的发生率较高.需机械通气的呼吸衰竭新生儿AJ的发生率高于机械通气者.未发现AJ与病死率相关.小剂量ACTH刺激试验可较好地评估新生儿肾上腺皮质功能.

Adrenal function of neonates with respiratory failure

Objective To observe the adrenal function in neonates with respiratory failure(neonatal respiratory distress syndrome,pneumonia and severe wet lung),the incidence of adrenal insufficiency,and the relationships between adrenal function and lung diseases.Methods Fifty-five cases of neonates(the preterm group of 33 cases,the term group of 22 cases)were enrolled the study.Serum cortisol values and plasma adrenocorticotropic hormone(ACTH)concentration were detected in the morning.Peak serum cortisol values were detected after 30 minutes low-dose(1 μg/1.73 m2)ACTH stimulation test.Adrenal insufficiency was defined as the peak serum cortisol values ＜ 200 μg/L.Results The mean basal serum cortisol values of the preterm group was significantly higher than that of the term group(139.2±85.4)μg/L vs(92.1±75.0)μg/L,P=0.0407],and the mean poststimulation increase cortisol level(122.3±56.4)μg/L vs(198.2±77.9)μg/L,P=0.000 1]and the mean ACTH level(5.22±2.40)ng/L vs(8.66±5.41)ng/L,P =0.008 4]of the preterm group were significantly lower than that of the term group.The total incidence of adrenal insufficiency in neonates with respiratory failure was 20.0%(11/55),and the incidence of adrenal insufficiency was 21.2%(7/33)in the preterm group and 18.2%(4/22)in the term group.Neonates who had the ventilatory requirements had significantly higher incidence of adrenal insufficiency than neonates who did not have the requirements(29.4% vs 4.8%,P = 0.037).None neonate with adrenal insufficiency died.Conclusion The adrenal and the pituitary function of preterm infants are poor than term infants.The incidence of adrenal insufficiency in neonates with respiratory failure is high,especially in the neonates who have the ventilatory requirements.We do not found relationship between the mortality and adrenal insufficiency.The low-dose ACTH test could be a valuable tool in assessing the function of HPA-axis in neonates with respiratory failure.