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目的:初步探讨小剂量(1μg/l.73 m2)促肾上腺皮质激素(ACTH)在危重患儿肾上腺功能评价中的价值。方法:重症监护室近5年来收治的患儿共150例进行小剂量ACTH刺激试验,试验前24 h内测定血液基础皮质醇(T1),静脉注射ACTH1μg/1.73 m2,30 min后测定刺激后血液皮质醇(T2)水平,计算皮质醇增值(T=T1-T2),同时结合T1判断其肾上腺功能。结果:150例患儿危重病相关性糖皮质激素障碍(CIRCI)总发生率为59.33%,重症感染组、大手术组及其非感染组CIRCI发生率分别为62.50%、58.00%、56.81%,三组比较差异无统计学意义。重症感染组、大手术组、非感染重症组T1分别为(36.17±47.34)、(32.56±50.43)、(27.39±16.49)μg/dL;T2分别为(51.09±49.32)、(59.45±74.53)、(45.21±15.45)μg/dL,两组比较差异均无统计学意义(P>0.05)。CIRCI组和正常反应组患儿病死率分别为8.99%、19.67%,差异无统计学意义。结论:危重患儿存在肾上腺功能障碍,小剂量ACTH刺激试验可用来评估危重患儿肾上腺功能,但单凭评估肾上腺功能并不能准确的预测疾病的严重程度及预后情况。
Objective: To investigate the value of adrenocorticotropic hormone (ACTH) in low dose (1μg / l.73m2) adrenal function in critically ill children. Methods: A total of 150 children admitted to intensive care unit in the recent 5 years were given low-dose ACTH stimulation test. Blood basic cortisol (T1) was measured within 24 hours before the test and ACTH1μg / 1.73m2 Cortisol (T2) levels, calculated cortisol value (T = T1-T2), combined with T1 to determine its adrenal function. Results: The overall incidence of CIRCI in critically ill patients was 59.33% in 150 cases, and 62.50%, 58.00% and 56.81% in severe infection group, major surgery group and non - infected group, respectively. No significant difference between the three groups was statistically significant. The scores of T1 in severe infection group, major surgery group and non-infected severe group were (36.17 ± 47.34), (32.56 ± 50.43) and (27.39 ± 16.49) μg / dL respectively, and those in T2 were 51.09 ± 49.32 and 59.45 ± 74.53, , (45.21 ± 15.45) μg / dL respectively. There was no significant difference between the two groups (P> 0.05). The mortality rates of CIRCI group and normal reaction group were 8.99% and 19.67% respectively, with no significant difference. Conclusion: Adrenal insufficiency exists in critically ill children. A small dose of ACTH stimulation test can be used to evaluate adrenal function in critically ill children. However, assessment of adrenal function alone can not accurately predict the severity and prognosis of the disease.