本文關(guān)鍵詞：冠狀動(dòng)脈搭橋術(shù)后繼發(fā)腎上腺皮質(zhì)功能不全的臨床觀察　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 冠脈搭橋術(shù) 腎上腺皮質(zhì)功能不全 危險(xiǎn)因素 臨床表現(xiàn) 診斷 治療

【摘要】：目的探討冠狀動(dòng)脈搭橋手術(shù)中和手術(shù)后出現(xiàn)相對(duì)腎上腺皮質(zhì)功能不全的幾率,可能的誘發(fā)因素及相關(guān)性,從而在今后的治療中對(duì)易患圍術(shù)期腎上腺皮質(zhì)功能不全的患者進(jìn)行及時(shí)發(fā)現(xiàn)和治療。 方法98例行冠狀動(dòng)脈搭橋手術(shù)患者術(shù)前抽取靜脈血檢測(cè)血皮質(zhì)醇濃度,與健康對(duì)照組比較。患者術(shù)后進(jìn)入重癥監(jiān)護(hù)室(ICU)后,均抽取血標(biāo)本進(jìn)行醛固酮、白蛋白、血糖、血鈉檢測(cè)。并進(jìn)行急性生理功能和慢性健康狀況評(píng)分(Acute Physiology and Chronic Health Evalurtion, APACHE-Ⅱ);進(jìn)入ICU次日晨行促腎上腺皮質(zhì)激素興奮試驗(yàn)(Adrenocorticotropic Hormone, ACTH),實(shí)驗(yàn)前后抽取血標(biāo)本檢測(cè)血醛固酮、皮質(zhì)醇濃度值。 結(jié)果1.病人組和對(duì)照組間年齡、性別、皮質(zhì)醇濃度比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義。 2.98例病人中有19例腎上腺功能不全,與促皮質(zhì)激素反應(yīng)良好78例患者的性別、年齡、血鈉、糖、血白蛋白濃度無(wú)差異。腎上腺功能不全組較腎上腺皮質(zhì)功能正常組血皮質(zhì)醇濃度T0值更高,APACHEII評(píng)分高,手術(shù)時(shí)間更長(zhǎng)。患者基礎(chǔ)皮質(zhì)醇濃度與APACHEII評(píng)分呈正相關(guān)。 3.19例腎上腺功能不全患者中體外循環(huán)麻醉11例,心臟不停跳麻醉8例,兩組發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異。 4.腎上腺功能減退組與功能無(wú)減退組行ACTH刺激試驗(yàn)前、試驗(yàn)后血醛固酮濃度值比較無(wú)統(tǒng)計(jì)學(xué)差異。 5.98例病人中發(fā)生低血壓24例。其中腎上腺功能減退組16例,腎上腺功能正常組8例。圍術(shù)期低血壓患者發(fā)生腎上腺功能不全幾率更大。結(jié)論冠狀動(dòng)脈搭橋術(shù)患者APACHEII評(píng)分、手術(shù)時(shí)間明均是影響圍術(shù)期出現(xiàn)相對(duì)腎上腺皮質(zhì)功能不全的誘發(fā)因素。而腎上腺皮質(zhì)功能不全發(fā)生率與是否選擇體外循環(huán)無(wú)明顯相關(guān)。
[Abstract]:Objective to investigate the incidence of relative adrenocortical dysfunction during and after coronary artery bypass grafting (CABG). Thus in the future treatment of patients prone to perioperative adrenocortical dysfunction timely detection and treatment. Methods Coronary artery bypass grafting was performed in 98 patients to detect the concentration of cortisol in venous blood before operation, and compared with that in the healthy control group. After the operation, the patients entered the intensive care unit (ICU). All blood samples were collected for aldosterone, albumin and blood sugar. Blood natrium test. Score of acute physiological function and chronic health status (. Acute Physiology and Chronic Health Evalurtion. APACHE- 鈪，

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