新生儿休克时体液因子改变与临床体征的关系

Relationship between humoral factors and clinical signs in neonates with shock

目的探讨新生儿休克时体液因子变化与临床体征之间的关系。方法应用高效液相色谱－电化学方法检测３６例休克新生儿血浆去甲肾上腺素、肾上腺素、肾素、血管紧张素Ⅱ、内皮素、皮质醇（ＣＴ）浓度，与休克时主要临床指标进行相关分析。结果去甲肾上腺素、肾上腺素、肾素、血管紧张素Ⅱ与温度、神志反应、股动脉搏动、心音、ｐＨ值、实际碱剩余呈显著负相关，与毛细血管再充盈时间、二氧化碳分压呈显著正相关，各种体液因子与皮肤颜色和血压均无相关性。表明新生儿休克时的体征主要来自机体对交感－肾上腺素系统和肾素－血管紧张素系统兴奋作出的反应。结论抢救休克时应以阻断交感神经持续兴奋和保护心功能为主要措施。

Objective To study the relationship between humoral factors and clinical signs in neonates with shock. Methods Plasma levels of norepinephrine (NE), epinephrine(E), angiotensin Ⅱ (AⅡ), endothelin (ET) and cortisol (CT) as well as renin activity (RA) were examined and clinical signs were observed in 36 cases. Results Each of NE, E, RA and AⅡ negatively correlated with each of body temperature ( P <0.05), consciousness ( P <0.01), femoral artery beat ( P < 0.01), heart sound ( P <0.05), blood pH ( P <0.05) and ABE value ( P <0.05), respectively and positively correlated with CRT ( P <0.01) and PaCO 2 ( P <0.05). But no correlation was found between humoral factors and skin colour and blood pressure. Conclusion Major signs of neonatal shock may mainly be due to excitation of sympathoadrenal and renin angiotensin system. Hence, blocking the excitation of sympathatic nervous system and preserving cardiac function should be considered as the principal options in treating neonatal shock.