糖皮质激素对吸入性肺炎患者临床预后的影响  

Effects of glucocorticoids on the clinical prognosis of patients with aspiration pneumonia

作　　者：鹿中华[1] 余维丽 曹利军[1] 尹路[1] 张频捷[1] 杨翔[1] 孙昀[1] LU Zhong-hua;YU Wei-li;CAO Li-jun;YIN Lu;ZHANG Pin-jie;YANG Xiang;SUN Yun(Department of Critical Care Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院重症医学科,安徽合肥230601

出　　处：《临床肺科杂志》2022年第9期1356-1361,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨糖皮质激素对吸入性肺炎患者临床疗效。方法回顾性分析我院ICU吸入性肺炎患者55例,根据是否给与糖皮质激素治疗分为对照组(28例)和糖皮质激素组(27例),分析两组患者基本资料、误吸后早期(3日内)与晚期(4~7日)病原学变化、机械通气时间、ICU及总住院时间、不良预后比率等,评价糖皮质激素对吸入性肺炎的疗效。结果糖皮质激素组患者入科时合并两个以上高危因素、呼吸频率、GCS评分更高,而需要CRRT的较少(P均<0.05)。两组患者在早、晚期病原学分布上无差异,但铜绿假单胞菌是早晚期常见病原菌。与早期比较,晚期病原学中鲍曼不动杆菌、金葡菌有增加趋势。给与激素治疗后,患者机械通气时间、ICU住院时间、总住院时间无差异,且激素组患者不良预后比例更高(P<0.05)。结论吸入性肺炎患者给与糖皮质激素治疗,未能使患者获益,未来需要更高质量的随机对照试验进一步验证。Objective To investigate the clinical effect of glucocorticoids on patients with aspiration pneumonia.Methods A retrospective study was conducted on 55 patients with aspiration pneumonia who met the admission and discharge standards in the intensive care department of our hospital from January 2020 to April 2021,and they were divided into control group(28 cases)and glucocorticoid group(27 cases)according to whether they were treated with glucocorticoid.The basic data,early(within 3 days)and late(4-7 days)etiological changes,mechanical ventilation time,ICU and total hospitalization time,and poor prognosis ratio after aspiration were analyzed,and the effect of glucocorticoid on inhalation was evaluated.Results Patients in the glucocorticoid group had a higher proportion of more than two risk factors,a faster initial respiratory rate,and a worse state of consciousness(GCS),while patients in the control group had a higher proportion of CRRT(all P<0.05).There was no significant difference in the pathogenic distribution between the two groups in the early and late stages,but Pseudomonas aeruginosa was a common pathogen in the early and late stages.Compared with the early etiology,Acinetobacter baumannii and S.aureus showed an increasing trend in late etiology.After glucocorticoid treatment,there was no significant difference in mechanical ventilation duration,ICU stays time,and total hospital stay time,while the proportion of patients in the glucocorticoid group with poor prognosis was higher(P<0.05).Conclusion Patients with aspiration pneumonia did not benefit from glucocorticoid treatment,future higher-quality randomized controlled trials are needed to clarify or confirm findings.

关 键 词：吸入性肺炎 糖皮质激素 临床预后 

分 类 号：R563.1[医药卫生—呼吸系统]