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目的探讨呼吸窘迫综合征(RDS)早产儿早期血清基础皮质醇和促肾上腺皮质激素(ACTH)水平变化及其与慢性肺疾病(CLD)的关系。方法选择2011年7月至2012年4月本院新生儿重症监护室(NICU)收治的RDS早产儿为观察组,同期入住本院早产儿病区的健康早产儿及产科出生的健康足月儿为对照组。所有对象均生后24 h内及生后第7天清晨8∶00~9∶00采集静脉血,采用化学发光法测定血清基础皮质醇和ACTH值,分析血清基础皮质醇和ACTH水平的变化;根据观察组患儿是否合并CLD分为CLD组和非CLD组,对CLD组和非CLD组患儿血清基础皮质醇和ACTH水平进行对比分析。结果观察组早产儿生后24 h内血清基础皮质醇水平高于第7天(P<0.05);生后24 h内血清基础皮质醇(μg/dl)和ACTH水平(pg/ml)均高于早产儿对照组及足月儿对照组[皮质醇:(23.6±8.7)比(18.8±6.6)、(19.5±6.4),ACTH:(49.0±12.2)比(41.0±13.3)、(41.0±8.9),P<0.05],生后第7天血清基础ACTH水平高于早产儿对照组及足月儿对照组[(48.0±10.2)比(38.4±11.9)、(39.1±7.2),P<0.05]。CLD组与非CLD组生后24 h内和第7天血清基础皮质醇和ACTH水平差异均无统计学意义(P>0.05)。结论 RDS早产儿早期处于应激状态且机体已具有一定的皮质醇分泌和调节功能,随着病情的好转皮质醇水平下降。胎龄在30~34周的RDS早产儿早期血清基础皮质醇和ACTH水平不能作为CLD的预测指标。
Objective To investigate the changes of serum basic cortisol and adrenocorticotropic hormone (ACTH) in early stage of respiratory distress syndrome (RDS) and their relationship with chronic lung disease (CLD). Methods From July 2011 to April 2012, premature infants with RDS admitted to neonatal intensive care unit (NICU) in our hospital were selected as the observation group. Healthy preterm infants and obstetric healthy term infants For the control group. Venous blood was collected within 24 h after birth and at 8:00 to 9:00 in the morning on the 7th day after birth. The levels of serum basic cortisol and ACTH were measured by chemiluminescence. Changes of serum basic cortisol and ACTH levels were analyzed. Group CLD children with or without CLD were divided into CLD group and non-CLD group, CLD group and non-CLD group serum basal cortisol and ACTH levels were analyzed. Results Serum basic cortisol level in preterm infants in observation group was significantly higher than that on day 7 (P <0.05) within 24 hours after birth. Serum basic cortisol (μg / dl) and ACTH level (pg / ml) (Cortisol: (23.6 ± 8.7) vs (18.8 ± 6.6), (19.5 ± 6.4), ACTH: (49.0 ± 12.2) vs (41.0 ± 13.3), (41.0 ± 8.9), P <0.05]. Serum ACTH levels at 7 days after birth were significantly higher than those in preterm infants and full-term infants (48.0 ± 10.2 vs 38.4 ± 11.9, 39.1 ± 7.2, P < 0.05]. There was no significant difference in serum Cortisol and ACTH between CLD group and non-CLD group within 24 h and 7 d after birth (P> 0.05). Conclusion RDS premature infants in early stress and the body has a certain degree of cortisol secretion and regulatory function, with the condition improved cortisol levels decreased. Early basal cortisol and ACTH levels in preterm infants with gestational age ranging from 30 to 34 weeks can not be used as predictors of CLD.