窒息新生儿低钠血症与心钠素、抗利尿激素水平关系的研究

A STUDY ON THE RELATIONSHIP BETWEEN ATRIAL NATRIURETIC PEPTIDE,ANTIDIURETIC HORMONE AND HYPONATRENMIA IN ASPHYXIATED NEONATES

目的 :探讨血浆心钠素 (ANP)与抗利尿激素 (ADH)在窒息新生儿合并低钠血症中所起的作用及其临床意义。方法 :应用放射免疫分析法对 4 0例窒息新生儿血浆ANP、ADH水平变化进行动态观察 ,并与 2 0例正常足月儿进行对照 ,同时观察补液量对血清钠变化的影响。结果 :①新生儿窒息急性期血浆ANP、ADH水平明显增高 ,窒息程度越重 ,血浆ANP、ADH水平越高 ,血清钠水平越低 (P <0 0 1)。②限水组生后一周血清钠水平已恢复正常 ,未限水组血清钠明显低于正常。结论 :ANP、ADH可影响窒息新生儿水盐代谢 ,引起以稀释性低钠血症为主的稀释性和失钠性低钠血症。治疗应严格控制液体量 <3 0～ 50ml·kg- 1/d ,适当补钠 。

Objective:To explore the effects of atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) in plasma on asphyxiated neonates with hyponatremia and its clinical values. Methods: In 40 asphyxiated neonates with hyponatremia and 20 normal term newborn infants, ANP and ADH levels in plasma were measured by radial immunoassay both in acute and recovery phases. At the same time,the effect of transfusion for serum sodium was observed. Results :① the plasma ANP and ADH levels of asphyxiated neonates in acute phase were significantly higher, The more serious the asphyxiated, the highter the ANP and ADH levels,and the lower the serum sodium ( p <0 01). ②In restricting fluids' infants, the serum sodium level recovered normally after birth one week, but in unrestricting fluids' infants the serum sodium was significantly lower. Conclusion:ANP and ADH may be involved in the water and salt metabolism in asphyxiated neonates . It may cause losed natrium and diluted hyponatremia that is more important. The therapy must be to restrict fluid under 30～50ml·kg -1 /d, to give some sodium and frusemide if necessary.