脓毒症休克早期应用小剂量糖皮质激素的效果评价  

Evaluation of Early Application of Low-dose Glucocorticoids in Septic Shock

作　　者：张春艳[1] 孙金昊[2] 李香兰[1] 张秀敏[1] 王晓静[1] 赵玉农[3] ZHANG Chun-yan;SUN Jin-hao;LI Xiang-lan;ZHANG Xiu-min;WANG Xiao-jing;ZHAO Yu-Nong(Department of Emergency,Hebei Chest Hospital, Shijiazhuang 050000, China;Department of Tuberculosis, Hebei Chest Hospital, Shijiazhuang 050000, China;Department of General Surgery, 256 Clinical Department, Bethune International Peace hHospital of PLA, Shijiazhuang 050000, China)

机构地区：[1]河北省胸科医院急诊科,石家庄050000 [2]河北省胸科医院结核科,石家庄050000 [3]解放军白求恩国际和平医院256临床部普泌外科,石家庄050000

出　　处：《临床误诊误治》2018年第12期54-57,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫计委重点科技研究计划(162247-5-1)

摘　　要：目的探讨脓毒症休克早期应用小剂量糖皮质激素的治疗效果。方法选择2016年3月—2018年3月收治的脓毒症休克52例,按照随机数字表法分为对照组及观察组,每组各26例。两组均予常规治疗,观察组在此基础上24 h持续泵入氢化可的松琥珀酸钠200 mg/d,连续应用5 d。记录两组治疗前、治疗12 h、治疗24 h、治疗48 h血流动力学(心率、平均动脉压)、氧合指数及治疗后各个时间点的乳酸清除率的变化,检测治疗前与治疗5 d外周血免疫功能(CD4+、CD8+及CD4+/CD8+)水平,观察重症监护病房住院时间和28 d病死率,分析不良反应发生情况。结果与对照组比较,观察组治疗24 h及48 h的心率降低、氧合指数升高,治疗24 h的平均动脉压及治疗48 h的乳酸清除率升高,差异有统计学意义(P <0. 05)。两组治疗前、治疗5 d的CD4+、CD8+、CD4+/CD8+比较差异无统计学意义(P> 0. 05)。观察组重症监护病房住院时间明显短于对照组,差异有统计学意义(P <0. 05);两组28 d病死率比较差异无统计学意义(P> 0. 05)。两组均未出现严重不良反应。结论早期应用小剂量糖皮质激素能够改善脓毒症休克患者的血流动力学及氧合指数,加速乳酸清除,且对机体免疫功能无明显影响。Objective To explore the effect of low-dose glucocorticoid in the treatment of patients with early-stage septic shock.Methods Fifty-two cases of septic shock treated in our hospital from March2016to March2018were divided into control group(n=26)and observation group(n=26)according to random number table method.Both groups were given conventional treatment.The observation group was given hydrocortisone sodium succinate200mg/d continuously for5d on the basis of conventional treatment for24h.The changes of hemodynamics[heart rate(HR),and mean arterial pressure(MAP)],oxygenation index(OI)and lactate clearance rate(LCR)were recorded before treatment,and12h,24h,and48h after treatment.Peripheral blood immune function(CD4+,CD8+and CD4+/CD8+)levels were measured before treatment and5d after treatment.In addition,the length of ICU stay and mortality within28d were observed and incidence of adverse effects was analyzed.Results Compared with the control group,HR was decreased and OI was increased24h and48h after treatment in the observation group.MAP24h after treatment and LCR48h after treatment were increased,and the difference was statistically significant(P<0.05).There was no significant difference in CD4+,CD8+,CD4+/CD8+before treatment and5d after treatment in both groups(P>0.05).Compared with the control group,the length of ICU stay of the observation group was shortened,and the difference was statistically significant(P<0.05).There was no significant difference in28-d mortality between the two groups(P>0.05).No serious adverse reactions occurred in either group.Conclusion Early application of small doses of glucocorticoids can improve hemodynamics and OI in patients with septic shock,and accelerate the clearance of lactic acid,which has no significant effect on immune function.

关 键 词：休克 脓毒性 糖皮质激素类 心率 乳酸 

分 类 号：R631.4[医药卫生—外科学]