摘要目的：观察因呼吸衰竭行机械通气的早产儿血浆皮质醇( Cor)、促皮质素( ACTH)水平的变化。方法选择2014年1月至12月收住安徽省儿童医院新生儿重症监护病房因呼吸衰竭行机械通气早产儿30例为早产呼吸衰竭组,选取同期住院因呼吸衰竭行机械通气的32例足月儿(足月呼吸衰竭组)、生命体征平稳的52例早产儿(早产对照组)及17例足月儿(足月对照组)作为对照,测定血浆Cor、ACTH水平,并进行统计学分析。结果1. Cor水平：3 d时,早产呼吸衰竭组[262.50(162.00~332.50) nmol/L]低于足月呼吸衰竭组[531.00(244.75~644.00) nmol/L],高于早产对照组[199.50(49.05~388.95) nmol/L]和足月对照组[120.00(43.90~191.00) nmol/L],差异均有统计学意义(P 均<0.05)；7 d 时,早产呼吸衰竭组[128.00(65.85~244．00) nmol/L]低于足月呼吸衰竭组[222.00(131.50~377.85) nmol/L],差异有统计学意义(P<0．05)。2. ACTH水平：3 d时,早产呼吸衰竭组高于其他组[38.20(25.18~76.65) pmol/L比24.60(19.03~38．20) pmol/L比22.30(14.40~40.60) pmol/L比24.20(13.90~45.65) pmol/L],组间差异有统计学意义(P<0.05)。7 d时,早产呼吸衰竭组ACTH水平显著下降,低于足月呼吸衰竭组[16.55(12.78~31.80) pmol/L比29.85(18．23~54.65) pmol/L],组间差异有统计学意义(P<0.05)。结论呼吸衰竭早产儿肾上腺皮质较呼吸衰竭足月儿呈低水平应答,而ACTH合成及分泌的能力较强,随着应激消失,Cor、ACTH恢复正常水平。

abstractsObjective To observe the concentration changes of plasma cortisol ( Cor ) and adrenocorticotropic hormone( ACTH) in preterm infants with respiratory failure receiving ventilation treatment. Methods The 30 preterm in-fants with respiratory failure requiring mechanical ventilation were selected as the preterm group with respiratory failure, and 32 full term infants with respiratory failure in need of mechanical ventilation were selected as the term infant group with respiratory failure, and 52 preterm infants( preterm control group) and 17 full term infants( term control group) were selected as controls. All the cases were chosen from Neonatal Intensive Care Unit of Anhui Province Children′s Hospital during January to December 2014. The levels of plasma Cor and ACTH were measured and analyzed. Results (1) Cor level:on the 3rd day, the level of plasma Cor in the preterm group with respiratory failure was lower than that in the term group with respiratory failure[262. 50(162. 00-332. 50) nmol/L vs 531. 00(244. 75-644. 00) nmol/L], and higher than those in the preterm control group[199. 50(49. 05-388. 95) nmol/L] and term control group[120. 00(43. 90-191. 00) nmol/L], the differences were statistically significant(all P<0. 05). On the 7th day, the level of plasma Cor in the preterm group with respiratory failure was lower than that in the term group with respiratory failure[128. 00(65. 85-244. 00) nmol/L vs 222. 00 (131. 50-377. 85) nmol/L], the difference was statistically significant(P<0. 05). (2) ACTH level:on the 3rd day, the level of ACTH in the preterm group with respiratory failure was higher than those in the other groups[38. 20(25. 18-76. 65) pmol/L vs 24. 60(19. 03-38. 20) pmol/L vs 22. 30(14. 40-40. 60) pmol/L vs 24. 20(13. 90-45. 65) pmol/L], the differences were statistically significant(P<0. 05). On the 7th day, the concentration of ACTH in the preterm group with respiratory failure was lower than those in the term group with respiratory failure[16. 55(12. 78-31. 80) pmol/L vs 29. 85(18. 23-54. 65) pmol/L], and there were statistical differences(P<0. 05). Conclusions The newborns with respiratory failure were in criti-cal stress, the level of plasma Cor in the preterm infants with respiratory failure was lower than that of the term infants with respiratory failure, while the level of ACTH in the former was higher than that in the latter. And when the stress disap-peared, both of the plasma Cor and ACTH recovered to the normal level.