小剂量氢化可的松治疗脓毒症休克的临床研究  

Effect of Low-dose Hydrocortisone in the Treating patients with Septic Shock

作　　者：林勇军[1] 熊滨[1] 吕立文[1] 王风[1] 韩林[1] 张静[1] 陈解语[1] 柳锋霖[1] 

机构地区：[1]广西壮族自治区人民医院,南宁市530021

出　　处：《广西医学》2011年第6期653-656,共4页Guangxi Medical Journal

基　　金：广西科学基金资助项目(0542064)

摘　　要：目的观察小剂量氢化可的松对脓毒症休克患者炎性反应的影响。方法将脓毒症休克患者80例随机分为治疗组42例与对照组38例,两组均给予常规治疗,治疗组在常规治疗的基础上加用小剂量氢化可的松,观察治疗前及治疗后4 h、12 h、24 h、48 h、72 h心率(HR)、平均动脉压(MAP)、心排血量指数(CI)、氧合指数(PaO2/FiO2);ELISA法测定血浆TNF-α、IL-1β、IL-6、IL-10;0 h、24 h、48 h、168 h行急性生理功能和慢性健康状况(APACHEⅡ)评分;测血乳酸含量;比较两组28 d病死率。结果治疗前两组患者上述指标水平差异无统计学意义(P>0.05)。与治疗前比较,两组治疗后各时点TNF-α、IL-1β和IL-6浓度均明显下降(P<0.05),但IL-10治疗前后差异无统计学意义(P>0.05);治疗后24 h、48 h、168 h APACHEⅡ评分、血乳酸均明显下降(P<0.05),与对照组相比,各时间点TNF-α、IL-1β、IL-6、APACHEⅡ评分下降更为显著(P<0.05);两组患者28 d病死率差异无统计学意义(P>0.05)。结论小剂量氢化可的松能减轻脓毒症休克患者的炎症反应,改善预后,为原发病治疗赢得时间与机会。Objective To study the effects of low-dose hydrocortisone on inflammatory response in the patients with septic shock.Methods Eighty patients with septic shock were randomly divided into treatment group and control group.Both groups were treated by routine therapy and treatment group by additional injection of low-dose hydrocortisone.The mean arterial pressure（MAP）,heart rate（HR）,cardiac index,PaO2/FiO2 were measured and recorded before（baseline）and at 4 hours,12 hours,24 hours,48 hours and 72 hours after intervention.Plasma levels of TNF-α,IL-1β,IL-6,IL-10 were detected by enzyme-linked immunosorbent assay（ELISA）respectively before（baseline）and at 4 hours,12 hours,24 hours,48 hours and 7 days after treatment.APACHEⅡ score and blood lactate acid level（BLA）were recorded before（baseline）and at 24 hours,48 hours and 7 days after treatment.The incidence of 28-day mortality between the two groups was compared.Results The indexes between the two groups were no significant differences before treatment（P0.05）.TNF-α,IL-1β,IL-6 were significantly decreased compared with the baseline values before treatment（P0.05）,while there was no significant changes in the plasma levels of IL-10（P0.05）,APACHEⅡ scores were significantly decreased after treatment（P0.05）.The levels of TNF-α,IL-1β and IL-6 at 4 hours,12 hours,24 hours,48 hours,and 7 days after treatment in treatment group were lower than those in control group at different time points（P0.05）,There was no significant difference in 28-day mortality between the two groups（P0.05）.Conclusion Low-dose hydrocortisone can inhibit inflammatory response in patients with septic shock,and provide a chance treating primary diseases in patients with septic shock.

关 键 词：脓毒症 休克 皮质醇 氢化可的松 

分 类 号：R541.64[医药卫生—心血管疾病]