不同剂量糖皮质激素对ARDS患者肺功能、脱机时间及预后影响的研究  

Effects of Different Doses of Glucocorticoid on Lung Function,Weaning Time and Prognosis in Patients With ARDS

作　　者：杨伟忠[1] 廖向飞 李利平 YANG Weizhong;LIAO Xiangfei;LI Liping(Emergency Department,Bo Luo Branch,Huizhou Central People's Hospital,Huizhou Guangdong 516100,China)

机构地区：[1]广东省惠州市中心人民医院博罗分院急诊科,广东惠州516100

出　　处：《中国卫生标准管理》2021年第7期101-103,共3页China Health Standard Management

基　　金：广东省惠州市科技计划项目(190327084578914)。

摘　　要：目的对比不同剂量糖皮质激素治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的安全性和有效性,观察给患者肺功能、脱机时间、预后带来的影响。方法抽选2019年1-11月期间医院收治的50例ARDS患者,以随机数字表法将其分入大剂量组、小剂量组两组,每组25例。其中小剂量组按照0.4 mg/(kg·d)的标准使用糖皮质激素--甲泼尼龙琥珀酸钠,大剂量组按照5 mg/(kg·d)的标准使用糖皮质激素。组间对比治疗前后患者肺功能指标、脱机时间、预后、不良反应发生率。结果比较治疗前两组的肺功能指标,差异无统计学意义(P>0.05)。治疗后,两组的氧合指数(oxygenation index,OI)、呼气终末正压(positive end-expiratory pressure,PEEP)均有明显改变,差异存在统计学意义(P<0.05),但两组相近,差异无统计学意义(P>0.05)。此外,两组的脱机时间、死亡率相近,差异无统计学意义(P>0.05)。两组的不良反应发生率差异有统计学意义(P<0.05)。结论不同剂量糖皮质激素均可以改善ARDS患者肺功能,缩短脱机时间,改善预后,但小剂量应用不良反应更少发生,其影响比大剂量使用更好。Objective To compare the safety and efficacy of different doses of glucocorticoids in the treatment of acute respiratory distress syndrome(acute respiratory distress syndrome,ARDS),and to observe the effects on the pulmonary function,weaning time and prognosis of patients.Methods 50 patients with ARDS admitted to our hospital from January to November 2019 were randomly divided into two groups:high dose group and low dose group,25 cases in each group.Glucocorticoids-methylprednisolone sodium succinate were used in small dose group according to the standard of 0.4 mg/(kg·d),and in large dose group according to the standard of 5 mg/(kg·d).The pulmonary function indexes,weaning time,prognosis and incidence of adverse reactions were compared before and after treatment.Results There was no significant difference between the two groups before treatment(P>0.05).After treatment,the oxygenation index(oxygenation index,OI)and positive end expiratory pressure(positive end-expiratory pressure,PEEP)of the two groups were significantly changed,the difference was statistically significant(P<0.05),but the two groups were similar,the difference was not statistically significant(P>0.05).In addition,the time of weaning,mortality rate of the two groups were similar,there was no significant difference(P>0.05).There was difference in the incidence of adverse reactions between the two groups,and there was statistical significance(P<0.05).Conclusion Different doses of glucocorticoids can improve the pulmonary function,shorten the time of weaning,and improve the prognosis of ARDS patients,but the adverse reactions of low-dose application are less,and its effect is better than that of high-dose application.

关 键 词：糖皮质激素 急性呼吸窘迫综合征 肺功能 氧合指数 呼气终末正压 脱机时间 

分 类 号：R714[医药卫生—妇产科学]