小剂量氢化可的松治疗脓毒症休克的效果分析  

Effect of low-dose hydrocortisone in the treatment of 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内科ICU,南宁530021

出　　处：《中国临床新医学》2011年第8期702-705,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西自然科学基金资助项目(编号:桂科自0542064)

摘　　要：目的研究小剂量氢化可的松对脓毒症休克患者炎性反应的影响和疗效。方法将脓毒症休克患者80例随机分为治疗组与对照组,对照组给予常规综合治疗,治疗组在常规综合治疗的基础上加用小剂量氢化可的松,分别于0、4、12、24、48、72 h测定心率(HR)、平均动脉压(MAP)、心排血量指数(cardiac index,CI)、氧合指数(PaO_2/FiO_2),治疗后24 h、48 h、7 d测定降钙素原(procalcitonin,PCT)、血乳酸含量,行急性生理功能和慢性健康状况(APACHEⅡ)评分,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)。两组治疗后24 h、48 h、7 d APACHEⅡ评分、PCT、血乳酸明显下降(P<0.05)。与对照组相比,治疗组各时间点APACHEⅡ评分、PCT均明显下降(P<0.05)。两组患者28 d生存率差异无统计学意义(P>0.05)。血皮质醇浓度与28 d病死生存率无明显相关性(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,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 and to evaluate the curative effect of low-dose hydroeortisone. Methods Eighty patients with septic shock were divided randomly into the treatment group and the control group. Both groups were treated by normal medicine and the treatment group by additional injection of low-dose hydrocortisone. MAP, HR, cardiac index, PaO2/FiO2 were measured and recorded before （ baseline ） and at 0,4, 12,24,48 h and 72 h after treatment. APACHEⅡ score,the levels of BLA and PCT were recorded before （baseline） and at 24 h,48 h and 72 d after treatment. Incidence of 28 d mortality between the treatment group and the control group were compared. Results The indexes of two groups were similar before treatment （P 〉 0.05 ）. APACHE Ⅱ score, BLA and PCT were significantly decreased compared with the baseline values before the treatment （ P 〈 0. 05 ） , the levels of APACHE Ⅱ score ,PCT in treatment group were lower than those in control group at according time（ P 〈 0. 05 ）, while there were no significant difference in 28 d mortality between the treatment group and the control group（P 〉0.05）. There were no association between cortisol levels and the 28 d mortality rate （P 〉 0. 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 降钙素原 皮质醇 氢化可的松 

分 类 号：R441.9[医药卫生—诊断学]