409例传染性非典型肺炎糖皮质激素应用的回顾性分析  

Retrospective Analysis of the Glucocorticoid Treatment in 409 Patients with Severe Acute Respiratory Syndrome

作　　者：丁可[1] 徐作军[1] 黄慧[1] 王臻[2] 徐莉莉[2] 童朝辉[2] 李兴旺[3] 郭利民[3] 吴昊[4] 黄春[4] 冯俐[5] 徐玉华[5] 王辰[2] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院呼吸内科,100730 [2]首都医科大学附属朝阳医院-北京呼吸疾病研究所 [3]北京地坛医院 [4]首都医科大学北京佑安医院 [5]北京胸科医院

出　　处：《实用全科医学》2005年第3期193-194,共2页Applied Journal Of General Practice

摘　　要：目的探讨糖皮质激素在传染性非典型肺炎(SARS)治疗中的作用。方法对409例SARS患者进行回顾性研究。根据激素使用与否、剂量及开始使用时间分组,分别比较普通型及重症患者各组在临床经过和预后上的差异。结果普通型中:①使用激素者的发热天数、病灶吸收时间较未用者长②未用激素者CD4+T细胞维持高于使用激素者水平;③未用激素组中无机械通气者,而激素治疗组中均有无创机械通气患者,>160mg组中占18.6%,显著高于其他两剂量组。重症中:①在病程8d以后开始用激素的患者的发热天数较1周内用激素者长。>80mg/d的激素两组呼吸道症状持续时间较长;②病灶吸收时间在各组中无显著差异;③在3d内即接受激素治疗者,不吸氧的比例高于未用激素者及8d后用激素者;>160mg/d组中需接受机械通气的患者明显高于未用激素者和其他2个剂量组;④>160mg/d组的预后显著差于其他组;激素开始使用时间对治愈率或死亡率无显著影响。结论早期激素治疗可以在一定程度上改善重症患者的氧合,控制发热,但仍应严格掌握适应证,合理应用。Objective To analyze the effect of glucocorticoid on SARS patients. Methods The use of glucocorticoid in 409 SARS patients was reviewed. The patients were divided into different groups according to the dosage or the time of the glucocorticoid administration, then we analyze the symptoms, X-ray changing, CD4 + T cell values, oxygen given and the prognosis of these patients. Results In the ordinary type patients who were treated with glucocorticoid, the persistent time of the fever and the X-ray abnormality were longer, and the levels of he CD4 + T lymphocyte subset were lower than those who were not. Those who accepted mechanical ventilation were all in the groups using glucocorticoid, especially in the group in which methylprednisolone dosage reached more than 160mg/day. On the other hand, in the severe patients, the persistent time of the fever became longer when glucocorticoid was administrated after the 8th day from the onset of the disease. The persistent time of cough and short of breath was longer when methylprednisolone were more than 80mg/day. The use of glucocorticoid had no relations to the improvement of the X-ray. The patients who needed no oxygen given were almost in the group in which glucocorticoid were administrated during the three days from the onset of the disease. Those who treated with Methylprednisolone of >160mg/day had more tendency to be treated with mechanical ventilation. There was no correlation either between the initial time of the glucocorticoid treatment and the rate of mechanical ventilation, or between the initial time of the glucocorticoid treatment and the cure rate or the mortality rate in the severe patients. Nevertheless, the prognosis was much worse in the group of Methylprednisolone of >160mg/day. Conclusions The use of glucocorticoid can improve the oxygenation in some degree, but we still should hold the indication strictly.

关 键 词：回顾性分析 传染性非典型肺炎(SARS) 激素应用 CD4^+T细胞 SARS患者 机械通气患者 重症患者 糖皮质激素 回顾性研究 呼吸道症状 激素使用 临床经过 持续时间 激素治疗 普通型 剂量 治疗组 治疗者 不吸氧 死亡率 治愈率 

分 类 号：R651.15[医药卫生—外科学] R511.01[医药卫生—临床医学]