危重病人血管紧张素Ⅱ与醛固酮的分离现象及其临床意义  

CLINICAL SIGNIFICANCE AND DISSOCCATION OF ANGIOTENSIN Ⅱ AND ALDOSTERONE IN CRIITICAL STRESSED PATIENTS

作　　者：霍开秀[1] 李小励[1] 钟荣[1] 唐盾[1] 何庆忠[1] 胡长玉[1] 

机构地区：[1]广西桂林医学院附属医院ICU,桂林541001

出　　处：《广西医科大学学报》2000年第2期216-218,共3页Journal of Guangxi Medical University

摘　　要：探讨危重病人血中血管紧张素 (A )与醛固酮 (AL D)的分离现象及其临床意义。方法 :测定 5 5例危重病人[按是否合并有多脏器功能失常综合征 (MODS)分为 A组 (合并 MODS组 )和 B组 (非 MODS组 ) ]和 35例健康正常人(C组 )血中皮质醇 (COR)、 A 和 AL D的含量。结果 :1A、B组的 COR、A 均显著高于 C组 (P <0 .0 1) ;A、 B两组比较差异不显著 (P>0 .0 5 ) ;而 A组 AL D的浓度显著低于 C组 (P<0 .0 1) ,也低于 B组 (P<0 .0 5 ) ,B组与 C组比较差异无显著性 (P >0 .0 5 ) ;2 A组病人低 AL D发生率为 5 4.5 5 % (12 /2 2 ) ,高于 B组的 2 7.2 7% (9/33,P <0 .0 5 ) ;A组高AL D发生率为 13.6 4% (3/2 2 )与 B组的 2 4.2 4% (8/33)差异无显著性 (P >0 .0 5 ) ;3低 AL D患者平均动脉血压明显低于高 AL D患者 (P <0 .0 5 ) ;低 AL D患者合并 MODS率、病死率明显高于高 AL D患者组 (P <0 .0 5 ) ;4AL D水平与 A-PACHE 评分间呈明显负相关 (r =- 0 .6 741,P <0 .0 0 1)。结论 :危重病人特别是合并 MODS的极危重患者中 A - AL D分离现象并非少见 ,且病情严重 ,预后差 ,病死率高。Objective:To research clinical significance and dissociation of angiotensin Ⅱ(AⅡ) and aldosterone (ALD) in critical stressed patients Methods:The concentrations of cortisol (COR),AⅡ and ALD were determined in 55 creitical stressed patients [which was subdivided into Group A (with multiple organ dysfunction syndrone,MODS) and Group B (without MODS)] and 35 normal subjects group (Group C) Result:The COR and AⅡ contents of Group A and B in critical patients were significantly higher than those of Group C (all P<0 01) The COR and AⅡ were not significantly different among Group A and B(all P>0 05) The plasmas of ALD in Group A (191 44±59 83)pmol/L were obviously lower than those in Group C (234 51±28 31)pmol/L,P<0 01 and lower than those in Group B (224 61±41 46)pmol/L,P<0 05 The ALD levels were not significantly different among Group B and C (P>0 05) The lower ALD rate in Group A (54 55%,12/22) was obviously higher than that of Group B (27 27%,9/33) (P<0 05) The higher ALD rate in Group A(13 64%,3/22) was not significantly dirrerent from that in Group B (24 24%,8/33)(P>0 05) The mean blood pressures in lower ALD group (6 51±3 50)kPa were significantly lower than those in higher ALD group (9 12±2 83)kPa(P<0 05) The MODS rate (57 14%) and death rate (53 28%) in lower ALD group were obviously higher than those (18 18%,9 09%) in higher ALD group (all P<0 05) The levels of ALD in critical patients had an obvious negative correlation with APACHEⅢ (n=55,r=-0 674 1,P<0 01) Conclusions:The dissociation of AⅡ and ALD in critical stressed patients (especially patients with MODS) is not rare There are higher severity of disease,and higher death rate in dissociation of AⅡ and ALD in critical stressed patients The mechanism and critical stressed patients were briefly discussed

关 键 词：皮质醇 血管紧张素Ⅱ 醛固酮 多器官衰竭 MODS 

分 类 号：R590.2[医药卫生—内科学]