应激剂量糖皮质激素在ARDS治疗中的应用效果  

Efficacy of stress-dose glucocorticoid in treatment of acute respiratory distress syndrome

作　　者：许红阳[1] 王大鹏[1] 臧芝栋[1] 姜淑云[1] 杨挺[1] 严洁[1] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏省214023

出　　处：《江苏医药》2016年第16期1786-1788,共3页Jiangsu Medical Journal

基　　金：无锡市医管中心面上项目(YGM1003)

摘　　要：目的探讨糖皮质激素治疗对急性呼吸窘迫综合征(ARDS)患者的病情及预后的影响。方法依据促肾上腺皮质激素(ACTH)刺激试验,将肾上腺皮质功能相对不全的ARDS患者43例随机分为两组:B组22例,采用常规治疗;A组21例,加用氢化可的松100mg静脉泵注,每8小时1次,连续7d。治疗前和治疗7d后,计算氧合指数(OI)和肺内分流率通气/血流比例(Qs/Qt),比较两组患者休克的发生率、ICU住院时间和住院28-d病死率。结果治疗7d后,两组患者的OI和Qs/Qt均较治疗前改善(P<0.05)。A组急性生理与慢性健康系统Ⅱ评分[(75.9±26.5)分vs.(97.3±24.8)分]、机械通气[(5.2±3.3)d vs.(6.2±4.7)d]和住ICU时间[(7.2±3.7)d vs.(8.1±4.3)d]、休克发生率(42.6%vs.73.2%)和住院28-d病死率(64.1%vs.79.3%)均低于B组(P<0.05)。结论对于合并肾上腺皮质功能相对不全的ARDS患者,加用应激剂量糖皮质激素治疗可降低休克的发生率和住院28-d病死率。Objective To investigate the effects of glucocorticoid on the illness and prognosis in the patients with acute respiratory distress syndrome（ARDS）. Methods Forty-three ARDS patients with relative insufficiency of adrenocortical function according to ACTH test were assigned into two groups of B（treated with conventional therapy, 22 cases）and A（treated with additional hydrocortisone 100 nag every 8 hours for 7 days）. Oxygenation index（OI） and intrapulmonary shunt （Qs/Qt） were calculated before and after treatment. The incidence of shock, ICU stay and 28-day hospital mortality were compared between two groups. Results Compared to before,the （）I and Qs/Qt were obviously improved in both groups after treatment（P〈0. 05）. The APACHE Ⅱ score after treatment[（75.9±26.5） points vs. （97.3±24.8） points] , mechanical ventilation time [（5.2±3.3） d vs. （6.2±4.7） d], ICU stay[（7.2±3. 7） d vs. （8. 1±4.3） d] , incidence of shock（42.6~ vs. 73.2%） and 28-day hospital mortality（64. 1% vs. 79.3%） were lower in group A than those in group B（P〈0. 05）. Conclusion On the basis of conventional therapy, additional use of stress-dose glucoconicoid can improve the illness state and reduce the 28-day hospital mortality in ARDS patients with relative insufficiency of adrenocortical function.

关 键 词：急性呼吸窘迫综合征 糖皮质激素 

分 类 号：R563[医药卫生—呼吸系统]