糖皮质激素在肺外感染致急性呼吸窘迫综合征抢救中的作用  

Effect of glucocorticoid (GC) in treatment of patients with acute respiratory distress syndrome (ARDS) extra-pulmonary infection

作　　者：宋志芳[1] 郭晓红[1] 单红卫[2] 俞康龙[3] 

机构地区：[1]上海第二医科大学附属新华医院成人ICU,上海200092 [2]上海第二军医大学附属长征医院急救科 [3]上海第二医科大学附属仁济医院急诊ICU

出　　处：《中华急诊医学杂志》2005年第10期832-835,共4页Chinese Journal of Emergency Medicine

基　　金：上海市卫生局科技发展基金资助项目(00409)

摘　　要：目的探讨糖皮质激素(GC)在肺外感染致急性呼吸窘迫综合征(ARDS)综合救治中价值。方法收集长征医院急救科1990年3月至2000年2月和新华医院内科ICU2000.052003.04收入因肺外感染诱发ARDS患者临床资料,比较GC与非GC组各项临床指标。结果32例患者中男/女为21/11例,年龄(51.2±19.1)岁,APACHEⅡ评分(28.2±9.7),接受机械通气治疗25例(78.1%),病死率65.6%(21/32);GC与非GC组年龄、APACHEⅡ评分、病死率之间差异无显著性(P>0.05);GC组PaO2/FiO2改善明显,(P<0.05,Qs/Qt差异无显著性(P>0.05),MODS和感染性休克发生率较非GC组低(P<0.05)。结论GC能协同常规治疗纠正缺氧和休克,为原发病治疗赢得时间与机会。Objective To evaluate the effect of glucocorticoid （GC） in treatment of patients with acute respiratory distress syndrome （ARDS） induced by extra-pulmonary infection. Methods The clinical data from all patients with ARDS induced by extra-pulmonary infection from March 1990 to Feb 2000 in ICU of Changzheng hospital and from May 2000 to April 2003 in ICU of Xinhua hospital were collected and analyzed. Results A total of 32 patients aged （51.2 ± 19.1 ） years old, with APACHE II score （28.2 ± 9.7） and mortality 65.6% （21/32）. Twenty-fine patients needed mechanical ventilation. Nineteen patients （59.4%） were treated with GC and their age, sex, APACHE II score and mortality were no significant difference compared with non-GC group （P 〉 0.05）. Their PaO2/FiO2 were improved significantly after treated with GC （P 〈 0.05） compared with non-GC group, respectively. Qs/Qr in both groups became lower without significant difference between them （ P 〉 0.05）. The incidence of MODS and septic shock in GC group were lower that than in non-GC group （P 〈 0.05 ）. Conclusion GC combined with routine treatment can improve oxygenation and shock and gain the chance for treating primmary diseases.

关 键 词：糖皮质激素 肺外感染 急性呼吸窘迫综合征 抢救措施 

分 类 号：R563.8[医药卫生—呼吸系统]