体外循环期间血浆ACTH与皮质醇浓度变化的研究

Study of Changes in Plasma ACTH and Cortisol during Cardiopulmonary Bypass

本实验用放射免疫测定方法，动态测定了２４例心内直视手术患者围术期的血浆ＡＣＴＨ与皮质醇浓度。结果发现：麻醉诱导后，ＡＣＴＨ及皮质醇的血浆浓度均稍有降低；转机后２０分钟，两激素浓度急剧下降，并且在转机４０分钟与６０分钟后，仍持续维持在较低水平；术后６小时，两激素血浆浓度明显高于术前对照值；术后第二天，两激素浓度基本恢复术前水平。本文认为：体外循环转机期间，机体存在明显的垂体一肾上腺皮质功能低下表现，因此转机中使用一定剂量的类固醇激素是合理的，本文并对体外循环期间影响垂体一肾上腺皮质功能的因素进行了讨论。

For better understanding of the response of pituitary-adrenal system during cardiopulmonary bypass,we measured plasma levels of ACTH and cortisol in 24 patients by radioimmunoassay.The results are as follows:(1)After induction of anesthesia,the levels of both ACTH and cortisol showed a slight decline.(2)After onset of CPB,the levels of ACTH and cortisol showed a sharp decline and maintained at a very low level throughout the bypass.(3)After operation,the levels of ACTH and cortisol rose again and were higher than preoperative levels in the early postoperative period and returned to normal after 2 days.The cause of hypofunction of pituitary-adrenal system during bypass and its clinical significance were discussed.