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find Author "高健婷 " 2 results
  • 危重患者肾上腺皮质功能状态与机械通气的撤离

    危重患者常常由于低氧血症或呼吸做功增加需要机械通气支持, 26% ~42% 的机械通气患者呈现不同程度的撤机困难 , 且撤机时间耗占整个机械通气时间的50% , 血流动力学不稳定是导致撤机失败的主要原因 。近年来研究发现严重疾病状态下, 由于下丘脑-垂体-肾上腺轴( HPA)的调节抑制、皮质醇储备和分泌不足、糖皮质激素抵抗等原因, 血管组织对儿茶酚胺的反应性降低导致血流动力学不稳定以及严重内环境紊乱, 也可能是影响撤机的重要原因。本文对危重患者肾上腺皮质功能的变化、肾上腺皮质功能与机械通气撤离的关系以及其机制做一综述。

    Release date:2016-08-30 11:55 Export PDF Favorites Scan
  • Adrenal Insufficiency in Critically Ill Patients and the Impact on Ventilator Weaning

    Objective To examine the adrenal function of critically ill patients received mechanical ventilation, and explore the relationship between the occurrence of relative adrenal insufficiency ( RAI) and weaning outcome.Methods Critically ill patients who were mechanically ventilated over 48 hours were enrolled in this study. Every patient was given one shot of corticotrophin 250 μg intravenously on the first day of admission and the first day of spontaneous-breathing-trial ( SBT) . Plasma contisol level was detected by radio-immunoassay before ( T0 ) and 30 minutes ( T30 ) after the shot. Meanwhile the following parameters were recorded including APACHEⅡ, age, and cause of disease, etc. RAI was defined as the difference between T0 and T30 ≤9 μg/dL. Receiver operating characteristic ( ROC) curve was used to evaluate the accuracy of the indicators towards the weaning outcome. Results A total of 45 patients with mechanical ventilation were recruited. The successful weaning group consisted 29 patients and the failure weaning group consisted 16 patients. The incidence of RAI in the successful weaning group ( 37.9% , 11/ 29) was significantly lower than that in the failure weaning group ( 75.0% , 12 /16) ( P=0. 017) . On the first day of admission, there was no significant difference of Δcortisol between the successful weaning group and the failure weaning group [ ( 10.3 ±5.7) μg/dL vs. ( 7.5 ±4.5) μg/dL, P=0.100) . On the first SBT day, Δcortisol of the successful weaning group was significantly higher than that in the failure weaning group [ ( 10.9 ±5.1) μg/dL vs. ( 4.9 ±2.9) μg/dL, P= 0.043] . Logistic regression analysis showed that Δcortisol was an independent risk factor of weaning. ROC curve analysis showed that on the first SBT day, the area under the curve of Δcortisol was 0.872; The sensitivity and the specificity of accurate judgmentwere 0.813 and 0.828 if Δcortisol ≤6. 95 μg/dL. Conclusions The occurrence of RAI is common in critically ill patients with mechanical ventilation. The adrenal function affects the outcome of weaning, and Δcortisol may be used as an important predictive indicator for weaning outcome.

    Release date:2016-09-13 04:00 Export PDF Favorites Scan
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