新生儿体外循环术后肾上腺皮质功能不全与预防性糖皮质激素对下丘脑-垂体-肾上腺轴功能的影响。

Adrenal insufficiency in neonates undergoing cardiopulmonary bypass and postoperative hypothalamic-pituitary-adrenal function after prophylactic glucocorticoids.

机构信息

Division of Neonatal-Perinatal, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA.

Department of Internal Medicine, University of Texas Southwestern Medical School, Dallax, TX, USA and Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA.

出版信息

J Perinatol. 2019 May;39(5):640-647. doi: 10.1038/s41372-019-0344-7. Epub 2019 Mar 12.

DOI:10.1038/s41372-019-0344-7

PMID:30867544

Abstract

OBJECTIVES

Determine incidence of preoperative adrenal insufficiency in neonates >35 weeks gestation with congenital heart disease undergoing cardiothoracic surgery with bypass and effects of prophylactic methylprednisolone on postoperative hypothalamic-pituitary-adrenal function and hemodynamic stability.

DESIGN

Prospective observational study in 36 neonates with preoperative adrenocorticotrophic hormone stimulation tests and serial total cortisol and adrenocorticotrophic hormone measurements before and after surgery. Data analyses: analysis of variance and regression.

RESULTS

Baseline circulating adrenocorticotrophic hormone and cortisol were unchanged 4-20 days postnatal (P > 0.1); however, cortisol levels rose with increasing adrenocorticotrophic hormone, P = 0.02. Ten neonates (29%) demonstrated preoperative adrenal insufficiency (∆cortisol ≤9 µg/dl); one had postoperative hemodynamic instability. Growth-restricted neonates had lower baseline cortisol, but normal stimulation tests and responded well to surgical stresses. Seventy-five percent of neonates receiving perioperative methylprednisolone demonstrated postoperative hypothalamic-pituitary-adrenal inhibition.

CONCLUSION

Adrenal insufficiency appears common in neonates >35 weeks gestation with congenital heart disease, but did not contribute to postoperative hemodynamic instability despite hypothalamic-pituitary-adrenal inhibition.

摘要

目的

确定行体外循环心脏手术的>35 周龄先天性心脏病新生儿的术前肾上腺功能不全发生率，以及预防性使用甲泼尼龙对术后下丘脑-垂体-肾上腺功能和血流动力学稳定性的影响。

设计

对 36 例新生儿进行术前促肾上腺皮质激素刺激试验，并在术前和术后进行系列总皮质醇和促肾上腺皮质激素测量的前瞻性观察性研究。数据分析：方差分析和回归分析。

结果

出生后 4-20 天，循环促肾上腺皮质激素和皮质醇的基线水平无变化（P>0.1）；然而，随着促肾上腺皮质激素的增加，皮质醇水平升高，P=0.02。10 例新生儿（29%）存在术前肾上腺功能不全（△皮质醇≤9μg/dl）；1 例术后出现血流动力学不稳定。生长受限的新生儿皮质醇基础值较低，但刺激试验正常，对手术应激反应良好。接受围手术期甲泼尼龙治疗的 75%新生儿出现术后下丘脑-垂体-肾上腺抑制。