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为探讨休克新生儿血管活性物质的变化规律及意义 ,采用分批观察 1 47例休克患儿的缩血管物质 :去甲肾上腺素 (NE)、肾上腺素 (E)、肾素 (RA)、血管紧张素 (A )、内皮素 (ET)、血栓素 A2 (TXA2 )、5 -羟色胺 (5 - HT) ;舒血管物质 :降钙素基因相关肽 (CGRP)、前列环素 (PGI2 )、β-内啡肽 (β- EP)。结果显示 :治疗前各种因子浓度均较正常对照组明显增高 ,表明新生儿机体对各种病理刺激的反应能力较完善。交感 -肾上腺素系统和肾素 -血管紧张素系统在新生儿休克的发生发展过程中起重要作用。前列环素物质在中度休克以 TXA2 增加占优势 ,重度休克时以 PGI2 分泌占优势 ,二者平衡失调是其特点。 β- EP浓度与休克程度平行 ,参与休克晚期低血压成因。多数缩血管活性物质与 p H值和 ABE呈负相关 ,与 PCO2 和 CRT呈正相关 ,这是缩血管效应。血压与各种体液因子无相关 ,只有在重度休克时才明显下降 ,表明血压不是早期休克的诊断指标。结论 :新生儿休克时以缩血管物质分泌占优势 ,治疗时应以扩血管药物为主 ,晚期休克提倡应用纳酪酮。
In order to explore the regularity and significance of the changes of vasoactive substances in neonates with shock, the vasoconstrictor substances (norepinephrine (NE), adrenaline (E), renin (RA) (A), endothelin (ET), thromboxane A2 (TXA2) and serotonin (5 - HT); vasodilators: calcitonin gene related peptide (CGRP), prostacyclin (PGI2) - Endorphin (β-EP). The results showed that: before treatment, the concentration of various factors were significantly higher than the normal control group, indicating that the neonatal body response to various pathological stimuli better. The sympathetic-adrenergic system and the renin-angiotensin system play an important role in the development of neonatal shock. Prostacyclin is predominately increased by TXA2 in moderate shock, and PGI2 predominates in severe shock, both of which are characterized by imbalance. β-EP concentration parallel to the degree of shock, involved in the causes of shock late hypotension. The majority of vasoconstrictors were negatively correlated with p H and ABE, and positively correlated with PCO2 and CRT as vasoconstrictors. No correlation was found between blood pressure and various humoral factors, and only significantly decreased during severe shock, indicating that blood pressure is not a diagnostic indicator of early shock. Conclusion: Neonatal shock vasoconstrictor predominates, vasodilator drugs should be used predominantly in treatment of neonatal shock. Late shock should promote the use of nattoone.