糖皮质激素在重症社区获得性肺炎中的治疗价值  

Therapeutic value of steroids in severe community-acquired pneumonia

作　　者：徐凌[1] 杨丹榕[1] 沈策[1] 边巍[1] 顾杰[1] 容朝晖[1] 

机构地区：[1]上海交通大学附属第六人民医院呼吸科,上海200233

出　　处：《中国实用内科杂志》2011年第11期856-858,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨糖皮质激素在重症社区获得性肺炎(CAP)中的治疗价值。方法回顾性分析上海交通大学附属第六人民医院2009年1月至2010年5月收治的102例重症CAP患者的临床资料,观察激素治疗组(46例)和非激素治疗组(56例)治疗相关指标。结果激素组氧合改善中位时间4 d,非激素组8.5 d,两组比较差异有统计学意义(P<0.05)。激素组体温恢复正常中位时间3 d,较非激素组(4 d)有缩短趋势,但差异无统计学意义(P=0.056)。激素组死亡5例(10.9%),非激素组7例(12.5%),差异无统计学意义(P=0.799)。亚组分析显示呼吸衰竭者接受激素治疗后住院时间与未接受激素治疗者相似(P=0.208),非呼吸衰竭者接受激素治疗后住院时间延长(P=0.025)。两组副反应发生率差异无统计学意义(P>0.05)。结论糖皮质激素治疗可加快重症CAP患者氧合的改善、体温的恢复,但不降低住院时间和病死率。哪些患者可从激素治疗中获益以及激素的最佳剂量和疗程仍需进一步研究。Objective To evaluate the value of steroids in the treatment of severe community-acquired pneu- monia （CAP）. Methods The clinical data from 102 patients with severe CAP registered to the Shanghai Sixth People＇s Hospital between January 2009 and May 2010 were reviewed. These patients were assigned to two groups depending on use of steroids, the steroids group （ n = 46） and non-steroids group （ n = 56）. Results The median time to improved oxygenation was 4 days in the teroids group vs 8. 5 days in the non-steroids group, reaching significant level of statistical difference （ P 〈 0. 05 ）. The median time to recovery of normal body temperature appeared shorter in the steroids group （3 days） compared with non-steroids group （4 days）, but this was not statistically significant （P =0. 056）. The death from severe CAP was comparable between the steroids （n = 5,10. 9% ） and non-steroids （n=7,12. 5% ） groups. A subgroup analysis, the length of hospital stay was comparable between patients with respiratory failure on steroids and those not on steroids （P = 0. 208 ） , but was longer in patients without respiratory failure on steroids than in those not on steroids （P = 0. 025 ）. The incidence of adverse events were similar between groups （ P 〉 0. 05 ）. Conclusion Treatment with steroids may be associated with quicker improvement in oxygenation and recovery in body temperature among patients with severe CAP, but not with length of hospital stay and death. Identification of patients who can benefit from steroids therapy, optimal dose and course of steroids should warrant further study.

关 键 词：社区获得性肺炎 糖皮质激素 

分 类 号：R563.1[医药卫生—呼吸系统]