糖皮质激素在脓毒症治疗中的研究进展  

The Research Progress of Glucocorticoids in the Treatment of Sepsis

作　　者：李志华[1] 刘宣[1] 葛勤敏[1] 王海嵘[1] 潘曙明[1] 

机构地区：[1]上海交通大学医学院附属新华医院急诊科,上海200092

出　　处：《现代生物医学进展》2015年第21期4191-4193,4197,共4页Progress in Modern Biomedicine

基　　金：上海市公共卫生人才培养计划(GWDTR201219)

摘　　要：脓毒症是由致病微生物感染引发的全身炎症反应综合征(SIRS),合并血压降低且经快速液体复苏后血压仍不能恢复正常者称为脓毒性休克(Septic shock),其中一部分患者发展为多器官功能障碍综合症(MODS)。脓毒症病死率居高不下。每10万人口中约50-300人会发生严重脓毒症,其短期死亡率达20%-25%,当发展为脓毒性休克时其死亡率达50%。整合消灭致病微生物、阻断炎症介质和处理MODS等措施的"集束化"治疗并未显著降低脓毒症患者的病死率。糖皮质激素具有强大的抗炎作用,但诸多的临床研究对糖皮质激素疗效的评价褒贬不一,糖皮质激素是否有利于脓毒症的转归一直饱受争议[3]。本文仅就糖皮质激素在严重脓毒症及脓毒性休克中的治疗进展综述如下,并希望能进一步探讨发生严重脓毒症及脓毒性休克时,机体对糖皮质激素反应复杂性的原因,以及在以后的研究中对相对肾上腺皮质功能不全的诊断标准及对糖皮质激素用药和停药时机的选择更加明确。Human sepsis is thought to be systemic inflammatory response syndrome （SIRS） that is activated by invasive infec- tion. It can rapidly develop into sever sepsis, septic shock and multiple organ dysfunction（MODS）. Severe sepsis places a large burden on health care systems,with an incidence ranging from 50 to 300 cases per000 population and a short-term mortality of 20% to 25%, reach- ing up to 50% when shock is present. Destructing pathogenic microorganisms,blocking inflammatory mediators and processing multiple organ dysfunction syndrome（MODS） did not significantly reduce the mortality of sepsis. Glucocorticoids have powerful anti-inflammato- ry effects,but the evaluations about the effect of glucocorticosteroid are varing. Whether it is good for the treatment of sepsis has been controversial. This review only discusses the progress of glucocorticoids in the treatment of severe sepsis and septic shock. We hope to continue to investigate the reason of the complexity of Glucocorticosteroids response when the patient developed into severe sepsis and septic shock. And the diagnose of the relative adrenal insufficiency and the chance of using and stoping of Glucocorticosteroids will be more clear in the future.

关 键 词：脓毒症 脓毒性休克 MODS 糖皮质激素 

分 类 号：R631.1[医药卫生—外科学]