肾上腺皮质功能状态对机械通气患者呼吸机撤离的影响

Effects of adrenal cortex function on ventilator weaning

目的评估机械通气患者肾上腺皮质功能状态，探究其对呼吸机撤离及预后的影响。方法选择入住衡水哈励逊国际和平医院ICU行机械通气且时间〉48h的患者，记录其年龄、性别、RSI、PO2/FiO2、APACHEII评分及引起呼吸衰竭上机的病因和合并症，于上机之初行ACTH（250μg）刺激试验评估其肾上腺皮质功能状态，以△cortisol≤9μg／dL判定合并肾上腺皮质功能不全，经筛查共56名患者纳为研究对象，随机分为治疗组（氢化可的松100mg静滴q8h）和安慰剂组，记录机械通气时间、撤机时Acortisol、ICU驻留时间、住院死亡率及随访28d死亡率情况，用SPSS软件对所得数据进行分析。结果：治疗组与安慰剂组在行机械通气时间、ICU驻留时间及成功拔管率存在统计学差异（P〈0．05），其。肾上腺皮质功能状态较上机时亦明显改善（P〈0．01），但住院死亡率和随访28d死亡率，差异无统计学意义（P〉O．05）。结论行机械通气患者合并肾上腺皮质功能不全的现象较常见，必要时给予激素替代补充治疗，可减少患者行机械通气的时间，提高成功拔管率，但尚未改善预后。

Objective To investigate the adrenal cortex function of patients receiving mechanical ventilation, and to study its effects on ventilator weaning and prognosis. Methods Patients who were admitted into our hospital and mechanically ventilated over 48 hours were enrolled in this study. The following parameters were recorded： age, gender, rapid sequence intubition （RSI）, PO2/FiO2, APACHE II scores, causes of mechanical ventilation and complications. Before mechanical ventilation, all patients was administrated with 250 μ g adrenocortico-tropic hormone （ACTH） to evaluate their adrenal function, where those with △ cortisol ≤ 9 μg/dL were set as adrenocortical insufficiency. Finally, 56 patients were enrolled and randomly divided into a treatment group given 100 mg hydrocortisone i.v.gtt q8h and a placebo group treated with 0.9% normal saline i.v.gtt q8 h. The during of mechanical ventilation, A cortisol at the time of ventilator weaning, ICU length of stay, in-hospital mortality and mortality after followed up for 28 days. The obtained data were analyzed by SPSS software. Results The treatment group showed significant difference in the duration mechanical ventilation, ICU length of stay and successful extubation rate compared with the placebo group （P 〈0.05）. Moreover, remarkable improvement was seen as to adrenal function in the treatment group after mechanical ventilation （P 〈0.01）. But the two groups presented no significant difference in in-hospital mortality and mortality after followed-up for 28 days （P 〉0.05）. Conclusion Adrenal dysfunction is quite common in patients during mechanical ventilation. Hormone replacement therapy can be provided if needed as an alternative therapy, which shortens the duration of mechanical ventilation and increases the rate of successful extubation. However, prognosis has not been improved.