早期应用小剂量琥珀酸氢化可的松对感染性休克治疗作用的探讨  

Effects of low - dose hydrocortisone succinate at early stage of septic shock

作　　者：郑亮亮[1] 袁莹[1] 李晨[2] 朱华栋[3] 徐军[3] 于学忠[3] 

机构地区：[1]北京医院急诊科,北京100730 [2]天津医科大学总医院急诊科,天津300052 [3]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730

出　　处：《中国急救医学》2015年第12期1088-1092,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨常规治疗基础上早期加用小剂量琥珀酸氢化可的松对感染性休克的治疗作用。方法选取北京协和医院急诊科收治的感染性休克患者37例，按照入院顺序的奇偶数将患者分为常规治疗组（对照组）和早期加用小剂量琥珀酸氢化可的松治疗组（研究组），比较两组患者入组时（dO）、24h（d1）、48h（d2）的血清白细胞介素-6（IL-6）、平均动脉压（MAP）、去甲肾上腺素（NE）使用量及乳酸清除率的变化，并比较14d病死率情况。结果两组患者d0时点血清IL-6水平、乳酸浓度、MAP比较差异无统计学意义（P〉0．05）。两组血清IL-6水平在d1[（58．93±108．39）pg／mLvs.（91．65±94．46）pg/mL]、d2[（30．52±48．81）pg／mLV8．（49．50±54．69）pg／mL]均出现明显下降，其中研究组下降更为明显（P值均〈0．05）；研究组相对于对照组MAP[d1：（74．84±5．11）mmHgVS．（68．78±4．49）mmHg，d2：（80．53±2．97）mmHgvs．（76．89±4．32）mmHg]、乳酸清除率[d1：（37．04±2．63）％V8．（19．21±3．21）％，d2：（54．89±6．72）％vs．（41．67±7．43）％]明显提高，NE使用量降低更为明显，且上述差异均有统计学意义（P〈0．05）；两组病死率比较差异无统计学意义（42．1％vs．44．4％，P〉0．05）。结论感染性休克常规治疗基础上早期加用琥珀酸氢化可的松可以进-步降低IL-6表达水平，有助于减轻炎症反应程度，并可能因此减少NE使用，提高MAP及乳酸清除率，从而更快地改善组织灌注，对感染性休克患者具有积极的辅助治疗作用。Objective To observe the effects of hydrocortisone succinate in addition to conventional therapy at early stage of septic shock. Methods Thirty - seven patients of septic shock were sequentially divided into conventional treatment group（ control group） and hydrocotisone in addition to conventional treatment group（ research group）. Serum interleukin -6 （IL- 6）, mean arterial pressure （MAP）, norepinephrine dosage and lactate clearance of the two groups on dayO （before treatment）, dayl and day2 were determined and compared. The mortalities were compared in 14 days between the two groups. Results There was no significant difference in the above parameters between the two groups at baseline（dO）. The serum levels of IL- 6 of both groups were significantly decreased on dl [ （58.93 ± 108.39） pg/mL vs. （ 91.65 ± 94.46 ） pg/mL ] and d2 [ （30.52 ± 48.81 ） pg/mL vs. （49.50 ± 54.69 ） pg/mL], and the treatment group decreased more apparently（ P 〈 0.05 ）]. Comparing to the control group, the dosage of norepinephrine was decreased more significantly, the MAP [ d1 ： （74.84 ±5.11 ） mm Hg vs. （68.78 ± 4.49） mm Hg, d2 ： （ 80.53 ± 2.97） mm Hg vs. （76.89 ±4.32） mm Hg） ] and the lactate clearance[dl ：（37.04 ±2.63）% vs. （19.21±3.21）%, d2：（54.89 ±6.72）% vs. （41.67 ±7.43% ）]were significantly higher in research group. But the 14 -day mortality was not statistically significant different between research group and control group （ 42. 1% vs. 44. 4%, P 〉 0. 05 ）. Conclusion Hydrocortisone succinate early added in routine treatment of septic shock could reduce inflammatory response by inhibiting the expression of IL - 6, and reduce the dosage of norepinephrine and improve MAP and lactate clearance. It could improve tissue perfusion faster and play a positive role in adjuvant therapy in patients with septic shock.

关 键 词：琥珀酸氢化可的松 感染性休克 白细胞介素-6(IL-6) 去甲肾上腺素(NE) 

分 类 号：R562.25[医药卫生—呼吸系统]