危重症新生儿肾上腺皮质功能状态的研究

目的:研究危重症新生儿肾上腺皮质功能状态、肾上腺皮质功能不全(AI)的发生率及其与患儿预后的关系。方法:选择我科收治的日龄2天的危重症新生儿52例(其中早产儿23例,足月儿29例),根据新生儿危重病例评分(NCIS)分为轻度危重组和重度危重组,分别检测其血清基础皮质醇和小剂量促肾上腺皮质激素(ACTH)刺激实验30分钟后的清皮质醇峰值。血清基础皮质醇15μg/dl为合并AI。结果:危重症早产儿基础皮质醇浓度及小剂量ACTH刺激实验前后皮质醇差值均较足月儿组低(15.08±4.98)μg/dl vs(19.65±9.18)μg/dl,P=0.027;(12.06±3.71)μg/dl vs(19.09±4.75)μg/dl,P=0.000]。危重症新生儿合并AI的发生率为38.5%,其中早产儿组为47.8%,足月儿组为34.5%。AI组新生儿死亡2例,未发现AI与患儿的死亡率有关。结论:危重症早产儿肾上腺皮质功能较足月儿差。危重症新生儿合并AI的发生率较高,但与患儿的死亡率无关。

Study on the Adrenal Function in Critically-ill Neonates

Objective： To investigate the adrenal function in neonates with critical illness, the incidence of adrenal insufficiency, and the relationship between adrenal insufficiency and the prognosis of neonates with critical illness. Methods： Fifty-two neonates enrolled were divided into two groups： the critically ill preterm infants and the critically ill term infants; then the two groups were separately divided into two groups according to neonatal critical illness score （NCIS）： moderate-critically ill group and severe-critically ill group. The cortisol of the neonates were detected. Alt the cases enrolled were stimulated with a low-dose ACTH, then the cortisol were detected 30 minutes later. Adrenal insufficiency was defined as the basal cortisol was less than 15μg/dl. Results： The basal cortisol values and the mean post-simulated increased cortisol level of the critically ill preterm group were lower than that of the term group （15.08± 4.98） μg/dl vs （19.65± 9.18） μg/dl, P=0.027; （12.06± 3.71） μg/dl vs （19.09± 4.75） μg/dl, P=0.000]. The total incidence of adrenal insufficiency in the critically neonates were 38.5%, and the incidence of AI in the preterm group was 47.8% and 34.5% in the term group. Two neonates with AI died. No relationship between AI and mortality of neonates with critical illness was found. Conclusions： The adrenal function of preterm infants was poorer than that of term infants. The incidence of AI in critically ill neonates was high, which was not correlated with the mortality of neonates with critical illness.