大剂量地塞米松与654-2对重度烧伤患者MODS的防治与机制  

Effects of high dose dexamethasone and anisodamine on the prevention and treatment of postburn MODS in severely burned patients and the mechanisms

作　　者：梁志刚[1] 李江 黄峻[1] 梁达荣[1] 霍丽贞[1] 刘锡麟[1] 

机构地区：[1]广州市红十字会医院烧伤整形科,广州510220 [2]山西省临汾地区烧伤治疗中心,临汾041000

出　　处：《第三军医大学学报》2003年第17期1570-1572,共3页Journal of Third Military Medical University

摘　　要：目的　探讨大剂量地塞米松与 65 4 2联合应用对重度烧伤患者MODS的防治作用及对患者血清中IL 2、SIL 2R浓度的影响。方法　 3 8例早期入院重度烧伤患者 ,随机分为大剂量应用组 (地塞米松 40mg、65 4 2 40mg ,每 8小时 1次 ,3d)与生理盐水对照组 (对照组 ) ,每组各 19例。治疗中对照组已发生MODS患者 18例 ,随机分为大剂量治疗组 (地塞米松 80mg每 4小时 1次、65 4 2 60mg每 8小时 1次 ,1d)与一般剂量组 (地塞米松 40mg、65 4 2 2 0mg ,每 8小时 1次 ,3d) ,每组 9例。ELISA法动态监测血清IL 2、sIL 2R水平 ,并观察患者脏器功能的变化、病情转归及大剂量组的副作用。结果　与对照组、一般剂量组相比 ,两大剂量组IL 2水平显著升高、sIL 2R水平显著降低 (P <0 .0 5 )。应用组MODS发生率、受损脏器数和重要内脏器官 (心、肺、肾、胃肠 )受损数均较对照组少 ;治疗组受损脏器恢复时间较一般剂量组短 ,MOF发生率及病死率均较一般剂量组少。且无明显副作用。结论　①大剂量地塞米松与 65 4 2联合应用对防、治重度烧伤后MODS均有积极作用 ,比一般剂量治疗效果明显。②防治机制可能与其影响sIL 2R及ILObjective To explore the effects of combined application of high dose dexamethasone and anisodamine on the prevention and treatment of postburn multiple organ dysfunction syndrome (MODS) and the serum levels of interleukin 2 (IL 2) and soluble interleukin 2 receptor (sIL 2R) in severely burned patients. Methods Thirty eight patients inflicted with severe burn during their shock stage were randomly divided into treatment group (treated with 40mg of dexamethasone and 40 mg of anisodamine, t.i.d. for 3 d) and control group (treated with normal saline). In control group, 18 cases suffering from MODS during treatment were randomly selected and divided equally into high dose group(treated with 80 mg of dexamethasone, 6 times a day and 60 mg anisodamine, t.i.d. for 1 d) and routine dose group(treated with 40 mg of dexamethasone and 20 mg of anisodamine, t.i.d. for 3 d). The serum levels of IL 2 and sIL 2R were dynamically monitored by ELISA and the functional changes of internal organs and treatment results and the side effects of high dose dexamethasone and anisodamine were observed. Results The serum IL 2 levels in two high dose groups were obviously higher than those in the control and routine dose groups but the sIL 2R levels in two high dose groups were evidently lower than those in the control and the routine dose groups ( P <0.05). The incidence of MODS, the number of injured organs and the injury incidence of important organs (heart, lung, kidney, gastrointestine) were lower than those in the control group. The recovery time of the injured organs in treatment group treated with high dose medicine was shorter than that in routine dose group and the multi organ failure (MOF) incidence and the mortality rate in high dose group were much lower than those in routine dose group. Conclusion Combined application of high doses of dexamethasone and anisodamine plays an important role in the prevention and treatment of postburn MODS. The preventive mechanism may be correlated with the changes of serum levels o

关 键 词：地塞米松 654—2 烧伤 IL-2、sIL-2R 多器管障碍综合征 

分 类 号：R442.8[医药卫生—诊断学] R644.053[医药卫生—临床医学]