窒息新生儿血糖、皮质醇、胰岛素水平变化及其临床意义

The change and its significance of blood glucose, cortisol and insulin levels in neonates with asphyxia

目的 观察窒息新生儿血糖(BG)、皮质醇(co)、胰岛素(InS)水平变 化,以探讨其临床意思。方法 用微量法和放免法检测40例正常新生儿和50例窒 息新生儿血糖、皮质醇、胰岛素。结果 窒息新生儿脐血BG、InS、Co明显升高,且与 窒息严重程度呈正相关(r值分别为0．36、0．31、0．33)。出生3 d BG和Co水平有所 降低,而InS水平无降低趋势。重度窒息组与对照组相比,各项水平差异显著(P< 0．01),且窒息组3 d时BG、Co水平与脐血相比有明显差异(P<0．05)。结论 应 激状态可造成BG、InS、Co升高,随窒息解除、病情缓解,胰岛素抵抗的恢复较血糖和 皮质醇恢复慢。在窒息抢救时,尤其是重度窒息儿,应密切监测血糖与激素变化,且 慎用糖皮质激素。

Objective To observe the change and its siginificance of blood glucose, cortisol and insulin levels in asphyxial neonates . Methods The level of glucose, cortisol and insulin in 40 normal neonates and 50 asphyxial neonates were measured with microdetermination and radioimmunoassay （RIA）. Results The levels of glucose, cortisol and insulin in umbilical blood were high significantly and correlated with the degree of asphyxia （rag =0.36,rIns =0.31,rCo =0.33）.The levels of BG and Co decreased 3 days after birth, the level of InS hadn＇t the tendency of decrease. The levels of three indexes were significant difference between severe asphyxial patients and controls （P 〈 0. 01 ）. Compared with umbilcial levels, there were distinctive differences in the levels of BG and Co at 3 days in asphyxial neonates. Conclusions Stress state can cause the elevation of BG, InS and Co levels. With the relief of asphyxia, the renewal of insulin resistance is slower than that of BG and Co. During the resuscitation, especially in serious asphyxial neonates, we should monitor the changes of BG and hormones closely .