中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
Chinese Pediatric Emergency Medicine
2015年
10期
672-675
,共4页
肾上腺危象%肾上腺功能障碍%诊断%治疗%儿童
腎上腺危象%腎上腺功能障礙%診斷%治療%兒童
신상선위상%신상선공능장애%진단%치료%인동
Adrenal crisis%Adrenal insufficiency%Diagnosis%Treatment%Children
肾上腺危象是肾上腺皮质功能障碍的危急重症,原因是由于肾上腺病变导致皮质激素缺乏(原发性肾上腺功能障碍),或下丘脑-垂体-肾上腺轴功能障碍导致促肾上腺皮质激素分泌的缺陷,使受其调控的肾上腺糖皮质激素分泌功能受损。感染或停服激素是肾上腺危象的主要触发因素,典型临床表现是低血容量性休克或低血压、恶心、呕吐和可的松反应敏感的发热反应。主要实验室特点是低血液皮质醇水平、低钠血症、低血糖症和(或)高钾血症。延误肾上腺功能障碍的诊断经常是发生致死性肾上腺危象的原因。危重症患儿疑似肾上腺危象或存在危象表现时,应及早使用经验性糖皮质激素替代治疗。
腎上腺危象是腎上腺皮質功能障礙的危急重癥,原因是由于腎上腺病變導緻皮質激素缺乏(原髮性腎上腺功能障礙),或下丘腦-垂體-腎上腺軸功能障礙導緻促腎上腺皮質激素分泌的缺陷,使受其調控的腎上腺糖皮質激素分泌功能受損。感染或停服激素是腎上腺危象的主要觸髮因素,典型臨床錶現是低血容量性休剋或低血壓、噁心、嘔吐和可的鬆反應敏感的髮熱反應。主要實驗室特點是低血液皮質醇水平、低鈉血癥、低血糖癥和(或)高鉀血癥。延誤腎上腺功能障礙的診斷經常是髮生緻死性腎上腺危象的原因。危重癥患兒疑似腎上腺危象或存在危象錶現時,應及早使用經驗性糖皮質激素替代治療。
신상선위상시신상선피질공능장애적위급중증,원인시유우신상선병변도치피질격소결핍(원발성신상선공능장애),혹하구뇌-수체-신상선축공능장애도치촉신상선피질격소분비적결함,사수기조공적신상선당피질격소분비공능수손。감염혹정복격소시신상선위상적주요촉발인소,전형림상표현시저혈용량성휴극혹저혈압、악심、구토화가적송반응민감적발열반응。주요실험실특점시저혈액피질순수평、저납혈증、저혈당증화(혹)고갑혈증。연오신상선공능장애적진단경상시발생치사성신상선위상적원인。위중증환인의사신상선위상혹존재위상표현시,응급조사용경험성당피질격소체대치료。
Adrenal crisis is a life-threatening emergency caused by the destruction or altered function of the adrenal gland with a primary deficit in cortisol secretion(primary adrenal insufficiency)or by hypotha-lamic-pituitary pathologies determining a deficit of adrenocorticotropic hormone(secondary adrenal insuffi-ciency).Infection and abrupt end glucocorticoid treatment are the major precipitating causes of adrenal crisis. Patients with adrenal crisis typically present with hypovolemic shock or hypotension,nausea,vomiting,and fe-ver responding well to parenteral hydrocortisone administration.The main laboratory findings include lower serum cortisol concentrations,hyponatremia,hypoglycaemia and/or hyperkalemia.Delay diagnosis of adrenal insufficiency leads to adrenal crisis which is potentially lethal complication.Empirical glucocorticoid replace-ment should be initiated as soon as the suspicious of adrenal crisis,or sooner if the patient presents in adrenal crisis in critically ill children.