小剂量激素用于外科术后感染性休克的临床研究  

Clinical Trail of Low-dose Corticosteroid Treatment for Surgical Postoperative Patients with Septic Shock

作　　者：万晓红[1] 苏美仙[1] 岳锦熙[1] 黄云龙[1] 朱炜华[1] 万林骏[1] 

机构地区：[1]昆明医科大学第二附属医院ICU,云南昆明650101

出　　处：《昆明医科大学学报》2014年第11期92-96,共5页Journal of Kunming Medical University

基　　金：云南省教育厅科学研究基金资助项目(2010C080);云南省卫生科技计划项目(2010NS050)

摘　　要：目的观察不同疗程小剂量激素用于外科术后感染性休克患者的疗效,探讨停药时机.方法收集2010年10月至2013年2月收住昆明医科大学第二附属医院ICU符合感染性休克诊断标准的外科术后患者89例,随机分为A、B、C 3组,所有患者于送入ICU 2 h内行ACTH刺激试验后,A组给予琥珀酸氢化可的松(50 mg,Q6 h,连用7 d)静脉注射,B组给予琥珀酸氢化可的松(50 mg,Q6 h,连用5 d)静脉注射,C组给予生理盐水.测定所有患者治疗前后血浆ACTH、皮质醇及IL-6水平并进行对照分析.观察感染性休克合并相对性肾上腺皮质功能不全的发生率以及不同疗程小剂量激素的疗效.结果外科术后感染性休克患者RAI的发生率为61.80%;使用激素的A、B 2组与C组相比,7 d及28 d病死率无统计学差异,但休克逆转时间缩短(P<0.05),3组相关并发症发生率无统计学差异.RAI和非RAI者相比,基础(治疗前)IL-6水平明显增高(P<0.01);激素治疗组中死亡者在激素治疗结束后的IL-6水平明显高于存活者(P<0.05);激素疗效和ACTH刺激试验结果无关.结论外科术后感染性休克患者相对性肾上腺皮质功能不全的发生率高;小剂量糖皮质激素(氢化可的松200 mg/d,5 d或7 d)可缩短感染性休克患者休克逆转时间,激素疗效和ACTH刺激试验结果无关;可考虑将IL-6水平的连续动态监测作为指导激素替代治疗疗程的一个指标.Objective To observe the effect of low-dose corticosteroid treatments with different courses on surgical postoperative patients with septic shock, and investigate the withdrawal time. Methods 89 patients diagnosed with septic shock in [CU from Oct 2010 to Feb 2013 were enrolled in this study. Patients were divided into groups A, B and C （control group） randomly. All patients were received ACTH stimulation tests within 2 hours after admitting in ICU, and then group A was treated with hydrocortisone 50 mg Q6 h for 7 days, group B was treated with hydrocortisone 50 mg Q6 h for 5 days, and the control group was treated with saline. The adrenocorticotropic hormone （ACTH） , cortisol （Cort） and interleukin-6 （IL-6） levels in serum were measured and compared before and after treatment. The incidence of relative adrenal insufficiency （RAI） in surgical postoperative patients with septic shock and the treatment effects of different courses were observed. Results The incidence of RAI in surgical postoperative patients with septic shock was 61.80%. Compared with control group, the mortalities of groups A and B had no differences in day-7 and day-28 （P 〉 0.05） , while shock reverse times shorted （P 〈 0.05） . There were no differences of complications among the three groups. Before treatment, the IL-6 level in RAI patients was significantly higher than that in non-RAI patients （P〈 0.01） . The IL-6 level in serum of death patients was higher than that of survival patients in groups A and B after treatment （P 〈 0.05） . The effect of corticosteroid treatment was not related to ACTH stimulation test. Conclusion The incidence of RAI in patients with postoperative septic shock is high. The low-dose Corticosteroid （hydrocortisone 200 mg/d, 5 d or 7 d） therapy can shorten shock-reverse-time in patients with septic shock. Continuously monitor for IL-6 levels in serum can be used as a marker to guaide the corticosteroid therany.

关 键 词：感染性休克 相对肾上腺皮质功能不全 皮质醇 IL-6 糖皮质激素治疗 

分 类 号：R692[医药卫生—泌尿科学]