CAJ | 학술논문

目的：对机械通气的重症患者进行肾上腺皮质功能状态分析，探讨相对性肾上腺皮质不全（RAI）与呼吸机撤离的关系，评价肾上腺皮质功能测定对呼吸机撤离及预后的意义。方法选择上海仁济医院急诊科及急诊ICU机械通气超过24 h的患者，使用250μg促肾上腺皮质激素（ACTH）静脉注射，测定刺激前及刺激后60 min血浆总皮质醇水平，即T60与T0，二者的差值ΔT≤9μg/dl定义为RAI。分析RAI与呼吸机撤离的相关性，使用Kaplan-Meier评价RAI与机械通气患者30 d存活率的相关性。结果共60例机械通气患者纳入研究，其中有创通气38例，无创通气22例；撤机成功24例，撤机失败36例。卡方检验显示，成功撤机组RAI患者比例明显著低于非RAI患者（P＝0.00011），并在有创通气组中更为明显。同时机械通气患者30 d存活率观察发现，合并RAI的患者死亡率明显高于非RAI通气患者（P＝0.0003）。结论 RAI明显影响有创通气的撤机成功率，并与机械通气的死亡率显著相关。
목적：대궤계통기적중증환자진행신상선피질공능상태분석，탐토상대성신상선피질불전（RAI）여호흡궤철리적관계，평개신상선피질공능측정대호흡궤철리급예후적의의。방법선택상해인제의원급진과급급진ICU궤계통기초과24 h적환자，사용250μg촉신상선피질격소（ACTH）정맥주사，측정자격전급자격후60 min혈장총피질순수평，즉T60여T0，이자적차치ΔT≤9μg/dl정의위RAI。분석RAI여호흡궤철리적상관성，사용Kaplan-Meier평개RAI여궤계통기환자30 d존활솔적상관성。결과공60례궤계통기환자납입연구，기중유창통기38례，무창통기22례；철궤성공24례，철궤실패36례。잡방검험현시，성공철궤조RAI환자비례명현저저우비RAI환자（P＝0.00011），병재유창통기조중경위명현。동시궤계통기환자30 d존활솔관찰발현，합병RAI적환자사망솔명현고우비RAI통기환자（P＝0.0003）。결론 RAI명현영향유창통기적철궤성공솔，병여궤계통기적사망솔현저상관。
Objective To examine the adrenal function of critically ill patients received mechanical ventilation, and explore the relationship between the relative adrenal insufficiency (RAI) and weaning outcome, evaluate the impaction of RAI impact on prognosis. Methods Critically ill patients who were mechanical ventilated over 24 hours were enrolled in this study. Each patient was given a bolus dose of 250 μg corticotrophin, plasma total cortisol level was detected at T0 and T60 (before and 60 minutes) after the shot and RAI defined as the difference between T0 and T60≤9 μg/dl. Chi-square test was used to analysis the correlation of the RAI and the weaning outcome, and Kaplan-Meiler was used evaluate the 30 days survival. Results A total of 60 patients with mechanical ventilation were recruited, including 38 invasive ventilation and 22 non-invasive. The successful weaning group consisted 24 patients and the failure weaning group was 36. The Chi-square test showed whether the incidence of RAI was significant correlation with weaning outcome (P=0.000 11), and more obvious in invasive group. Observation of the rate of 30 days survival rate were observed by the Kaplan-Meiler, it showed mortality of RAI incident in ventilated patients was significantly higher than non-RAI group (P=0.000 3). Conclusion The occurrence of RAI significantly affect the rate of weaning in invasive ventilated patients;and is significantly associated with the mortality of ventilation.