促肾上腺皮质激素刺激对脓毒症及脓毒性休克患儿肾上腺功能评估的意义  

Adrenal function evaluation using ACTH stimulation test in children with sepsis and septic shock

作　　者：张育才[1] 章赛吉[1] 滕国良[1] 田国力[1] 徐梁[1] 曹瑞芬[1] 张宇鸣[1] 

机构地区：[1]上海交通大学附属儿童医院急救中心上海交通大学儿科危重病研究所,200040

出　　处：《中华儿科杂志》2008年第5期328-332,共5页Chinese Journal of Pediatrics

摘　　要：目的探讨小剂量（1μg／1．73m^2）促肾上腺皮质激素（ACTH）刺激实验评估儿童脓毒症和脓毒性休克肾上腺功能状态的价值。方法患儿入院24h内完成基础皮质醇（T0）测定，静脉注射1μg／1．73m^2ACTH，30min后测定血液皮质醇（T1），根据哟和皮质醇增值（Δmax=T1～T0）判断肾上腺功能，以Amax≤90μg／L为肾上腺功能障碍（AI）指标。结果62例中，脓毒症53例，脓毒性休克9例，病死率为27．4％（17／62）。肾上腺功能障碍（adrenal insufficiency，AI）发生率40．3％（25／62），其中脓毒症和脓毒性休克患儿AI发生率分别是39．6％和44．4％．差异无显著统计学意义（P〉0．05）。两组脓毒症和脓毒性休克平均T0和T1分别是（318．6±230．4）μg／L、（452．3±230．7）μg／L和（454．7±212．7）μg／L、（579．3±231．9）μg／L，差异无统计学意义（P〉0．05）。存活组和死亡组患儿T0、T1分别是（320．5±223．9）μg／L、（462．3±212．0）μg／L和（384．3±258．3）μg／L、（500．7±470．6）μg／L，两组AI发生率分别是37．8％和47．1％，差异无统计学意义（P〉0．05）。T0和T1水平与儿童危重病例评分（PCIS）有关（P〈0．05），AI发生率与PCIS、PRISMⅢ和器官功能障碍数目无关（P〉0．05）。结论儿童脓毒症和脓毒性休克患儿AI发生率较高。小剂量ACTH刺激实验可以判断严重感染患者肾上腺功能，可为激素治疗提供依据。Objective Sepsis and septic shock remain a common problem that results in significant mortality and morbidity in pediatric intensive care units（PICU）. According to literature, the use of more physiologic steroid replacement therapy is associated with hemodynamic and survival benefits in adult patients with relative adrenal insufficiency （RAI） and catecholamine-resistant septic shock. But little information is available in children. The aim of the current prospective study was to determine the prevalence of adrenal insufficiency in children with sepsis and septic shock using a low-dose adrenocorticotropic hormone（ACTH） stimulation test （1 μg/1.73 m^2） in children. Methods The authors performed cortisol estimation at baseline and after low-dose （ 1 μg/1.73m^2 ） ACTH stimulation at 30 mins in children during the first 24 hours in patients with sepsis or septic shock admitted to our PICU. Adrenal insufficiency was defined as a response ≤90 μg/L. Absolute adrenal insufficiency （AAI） was further defined as baseline cortisol （T0） 〈 200 μg/L and RAI insufficiency by T0 ≥200 μg/L Results Sixty-two consecutive cases with sepsis and septic shock admitted to PICU of Shanghai Jiaotong University Affiliated Children＇s Hospital from April, 2006 to March, 2007. The median age was 37.6 months （range, 2-168 months）, and their gender distribution was 42 （67.7%） males and 20（32. 3% ） females, 53 cases had sepsis （85.5%） and 9 had septic shock （ 14. 5% ） . The mean pediatric critical illness score （ PCIS ） was 79. 3 ± 9. 2 and median pediatric risk of mortality score （ PRMSⅢ ） 11.3 （5-19） , respectively. Overall mortality of sepsis and septic shock was 27.42%. The evaluation of adrenal insufficiency was＇conducted as follows. （1） The mean cortisol levels at baseline （TO） and 30 mins after ACTH stimulation （T1） were（318. 6 ±230. 4） μg/L, （452. 3 ± 230. 7 ） μg/L and （ 454. 7 ± 212. 7 ） μg/L, （ 579. 3 ± 231.9 ） μg/L in patien

关 键 词：脓毒症 全身炎症反应综合征 休克 脓毒性 重症监护病房 儿科 

分 类 号：R686[医药卫生—骨科学]