窒息新生儿肾上腺皮质激素水平的变化及临床意义分析

Changes and Clinical Significance of Adrenocortical Hormone Levels in Asphyxiated Term Infants.

【目的】 了解窒息新生儿激素水平在应激状态下的改变 ,探讨地塞米松对窒息新生儿体内激素水平的影响。 【方法】 分别对 3 8例足月窒息儿 (A组、B组 )、2 0例足月健康儿 (C组 ) ,于生后第 1、2、3、5、10d抽血检测血浆儿茶酚胺 (CA)、皮质醇 (Cor)、醛固酮 (Ald) ,观察其水平变化。 【结果】 ①C组血浆Cor、Ald随日龄增长而下降 ,CA水平较稳定 ;②A组生后第 1d三个指标均明显高于C组 (P <0 .0 1) ,第 10d与C组比较差异无显著意义 (P >0 .0 5 ) ;③B组地塞米松治疗后 3～ 5d ,上述三指标均有不同程度下降 ,但仅血浆CA较A组相应日龄值明显降低 (P <0 .0 1) ,而血浆Cor、Ald值下降无统计学意义 (P >0 .0 5 ) ,第 10d恢复至正常组水平。 【结论】 新生儿生后CA、Cor、Ald的正常值应依日龄而定 ;窒息应激时 ,易发生内分泌失衡。而短期Dex应用对内分泌系统仅产生短暂轻度抑制。

To investigate the dynamicvariation of plasma catecholamine(CA)?cortisol(Cor)?aldosteron(Ald) in the normal term infants and the asphyxiated term infants; Determine the effects of dexamethasone(DEX)therapy on the neonatal endocrine. The plasma levels of CA?Cor?Ald were measured simutaneously on day 1,2,3,5,10 after birth in 38 asphyxiated term infants,among which 18cases were treated with DEX , 20cases without DEX ;20 normal term newborns as a control. ① Levels of plasma Cor?Ald decreased gradually with age and levels of CA were stable in the normal term infants; ② There was a a significant increase of the levels of CA?Cor?Ald in asphyxiated neonates on day 1,2,3,5 after birth( P <0.01) and became normal on day 10( P >0.05); ③ Plasma CA values declined significantly on day 5 in the neonates treated with DEX compared with those without DEX therapy( P <0.01); Levels of plasma Cor?Ald also decreased on day 5,but no statistic significance were found( P >0.05).[Conclusions] In the neonatal period ,the normal plasma levels of CA?Cor and Ald should be interpreted in accordance with age because of the physiological fluctuation; Perinatal asphyxia might be a potent stimuli for CA?Cor and Ald release,and the DEX therapy could suppress plasma levels of CA?Cor and Ald partialy only for a short time.