小剂量氢化可的松对感染性休克患者血乳酸的影响  

Effect of low-dose hydrocortisone on the concentration of BLA in patients with septic shock

作　　者：柳锋霖[1] 熊滨[1] 林勇军[1] 张静[1] 

机构地区：[1]广西壮族自治区人民医院重症医学科一区,南宁530021

出　　处：《中国临床新医学》2012年第5期389-392,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感染性休克患者血流动力学以及动脉血乳酸浓度的影响。方法将感染性休克患者80例随机分为治疗组与对照组各40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治疗,治疗后4、12、24、48 h及7 d进行心率(HR)、平均动脉压(MAP)、心脏指数(CI)监测以及动脉血乳酸测定,并在治疗后24、48 h及7 d行急性生理功能和慢性健康状况(APACHⅡ)评分,记录28 d病死率。结果治疗前两组患者各血流动力学指标、APACHEⅡ评分以及动脉血乳酸浓度差异无统计学意义(P>0.05)。与对照组相比,治疗组4 h后各时间点HR、MAP、CI均有明显改善(P<0.05);与治疗前比较,治疗组4～12 h血乳酸浓度较治疗前明显下降(P<0.05);而与对照组比较,治疗组在4、12、24 h及7 d各时点均有明显下降(P<0.05);治疗组与对照组相比,血管活性药物使用时间减少(P<0.05),28 d病死率明显降低(P<0.05)。结论小剂量氢化可的松能有效地改善患者组织灌注以及全身氧代谢,从而提高感染性休克患者抢救成功率。Objective To study the effects of low-dose hydrocortisone on hemodynamics and the concentra- tion of BLA（blood lactic acid） in the patients with septic shock. Methods Eighty patients with septic shock were di- vided randomly into the treatment group and the control group. Both groups were treated by normal medicine and the treatment group by low-dose hydrocortisone additional injection. HR, MAP, CI and BLA respectively before-（ base- line） and at 4,12,24,48 h and 7 d after the treatment were monitored. APACHE II score were recorded before （baseline） and at 24, 48 h and 7 d after the treatment. Mortality rate was compared on 2gth day. Results The inde- xes of two groups were similar before treatment （ P 〉 0. 05 ）. In the treatment group, compared with control group, HR,MAP and CI at every time point were significantly improvement; compared with the baseline values before the treatment （ P 〈 0. 05 ） ; the concentration of BLA at 4 - 12 h after the treatment significant decreased （ P 〈 0. 05 ）, and compared with the contrd group, the concentration of BLA at 4 h, 12 h,24 h,7 d were decreased（P 〈 0.05 ） ; the application time of catecholamine infusions in treatment group was less than that of control group. The 28d mortality rate in the treatment group was significantly lower than that in the control group （ P 〈 0. 05 ）. Conclusion Low-dose hy-drocortisone can improve the tissue perfusion and systemic oxygen metabolism in patients with septic shock,which can raise successful rescue rate.

关 键 词：感染性休克 血乳酸 氢化可的松 

分 类 号：R441.9[医药卫生—诊断学]