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目的:以早产儿血清皮质醇水平作为监测指标,观察不同临床因素对皮质醇水平变化的影响。方法:出生72 h内转入湖南省儿童医院新生儿科的早产儿90例(胎龄<37周),排除遗传代谢性疾病,母孕期及患儿出生时均未用过肾上腺皮质激素,全部患儿在入院时(生后72 h内)静脉采血,留取血标本,分离血清,采用放射免疫法检测血清皮质醇水平。结果:危重组早产儿血清皮质醇水平高于非危重组(t=2.601,P<0.05),机械通气组早产儿皮质醇水平显著高于非机械通气组(t=3.134,P<0.01),低出生体重组早产儿皮质醇水平低于正常体重组(t=2.194,P<0.05);不同分娩方式、不同胎龄、有无低血糖、有无消化道出血、有无低血压组间皮质醇水平比较,差异均无统计学意义(P>0.05)。结论:早产儿应激发生时机体已具有调节皮质醇分泌的能力,血清皮质醇浓度增高与其成熟度、病情危重程度有关。
OBJECTIVE: To evaluate the effect of different clinical factors on the changes of cortisol levels in preterm children with serum cortisol level as a monitoring indicator. Methods: Ninety preterm infants (gestational age <37 weeks) who were transferred to neonatology department of Children’s Hospital of Hunan Province within 72 hours of birth were excluded from genetic metabolic diseases. All of them had not been used during the first trimester of pregnancy and their children were born. Children were admitted to hospital (72 h after birth) venous blood, blood samples were taken, serum was separated, serum cortisol levels were measured by radioimmunoassay. Results: Serum cortisol levels in preterm infants in critically ill group were significantly higher than those in non-critically ill group (t = 2.601, P <0.05). Cortisol level in preterm infants in mechanical ventilation group was significantly higher than that in non-mechanical ventilatory group (t = 3.134, The levels of cortisol in preterm infants with low birth weight were lower than those in normal weight group (t = 2.194, P <0.05). There was no significant difference in cesarean section between preterm infants with low birth weight and those with low birth weight Alcohol levels, the difference was not statistically significant (P> 0.05). Conclusion: The premature infant has the ability to regulate the secretion of cortisol when stress occurs. The increase of serum cortisol level is related to its maturity and severity of illness.