Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Clin Endocrinol (Oxf). 2011 Mar;74(3):354-64. doi: 10.1111/j.1365-2265.2010.03927.x.
Recent studies suggest that refractory hypotension from causes other than septicaemia or cardiac failure is common in extremely preterm infants even out of the transitional period. Marked response to low-dose cortisol suggests underlying adrenal insufficiency, although the exact mechanism remains unknown.
To investigate potential triggers for and related short-term outcomes of early-onset (<Day 7) and late-onset (≥Day 7) refractory hypotension, clinical data for 70 infants <30 weeks gestation were assessed.
The incidence of early-onset refractory hypotension (n=7) was correlated with younger gestational ages <26 weeks (P < 0.05), whereas the incidence of late-onset refractory hypotension (n=14) was correlated with younger gestational ages and levothyroxine supplementation (P<0.05 and 0.01, respectively). The incidence of both early- and late-onset refractory hypotension was correlated with risks of short-term adverse outcomes such as prolonged mechanical ventilation and hospital stay.
Levothyroxine supplementation was identified as an independent variable correlated with an increased incidence of refractory hypotension out of the transitional period; as seen in hypothyroidism with Addison's disease, the immature hypothalamic-pituitary-adrenal axis may not respond properly to the increased demand for cortisol, which may precipitate premature infants into refractory hypotension. Following the administration of levothyroxine, preterm infants may have to be carefully monitored for early signs of refractory hypotension.
最近的研究表明，即使在过渡阶段之外，败血症或心力衰竭以外的原因引起的难治性低血压在极早产儿中也很常见。小剂量皮质醇的明显反应表明存在潜在的肾上腺功能不全，尽管确切的机制尚不清楚。
为了研究早期（<第 7 天）和晚期（≥第 7 天）难治性低血压的潜在触发因素及其相关短期结局，评估了 70 名胎龄<30 周的婴儿的临床数据。
早期难治性低血压（n=7）的发生率与<26 周的更年轻胎龄（P<0.05）相关，而晚期难治性低血压（n=14）的发生率与更年轻的胎龄和左甲状腺素补充相关（P<0.05 和 0.01）。早期和晚期难治性低血压的发生率均与短期不良结局（如延长机械通气和住院时间）的风险相关。
左甲状腺素补充被确定为与过渡阶段后难治性低血压发生率增加相关的独立变量；正如艾迪生病中的甲状腺功能减退症所见，不成熟的下丘脑-垂体-肾上腺轴可能无法对皮质醇需求的增加做出适当反应，这可能使早产儿陷入难治性低血压。在给予左甲状腺素后，早产儿可能需要密切监测早期难治性低血压的迹象。
