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2017 年第 12 期 第 12 卷

氢化可的松治疗早期脓毒症相关急性呼吸窘迫综合征的临床效果

作者:房阁宋根红林小艳

英文作者:

单位:716000延安大学附属医院重症医学科

英文单位:

关键词:脓毒症相关急性呼吸窘迫综合征;氢化可的松

英文关键词:

  • 摘要:
  • 目的    探讨氢化可的松治疗早期脓毒症相关急性呼吸窘迫综合征(ARDS)的临床效果。方法    选取2010年1月至2015年12月延安大学附属医院的早期脓毒症相关ARDS患者80例,依据随机数字表法分为2组,一组接受氢化可的松静脉注射治疗(50 mg/次,1次/6 h,连续治疗7 d)(观察组),另一组接受等剂量0.9%氯化钠注射液作为安慰剂(对照组),各40例。记录2组患者治疗后氧合指数、肺损伤评分及死亡情况的变化。应用单因素与多因素非条件Logistic回归分析影响患者28 d生存率的因素。记录患者的不良反应发生情况。结果    观察组潮气量明显低于对照组,差异有统计学意义(P=0.04);2组余临床资料比较差异均无统计学意义(均P>0.05)。治疗1~7 d与14 d后,观察组氧合指数明显高于对照组,肺损伤评分明显低于对照组,差异均有统计学意义[治疗1 d后:(226±12)mmHg(1 mmHg=0.133 kPa)比(192±11)mmHg、(1.82±0.23)分比(2.26±0.65)分,治疗7 d后:(313±15)mmHg比(289±15)mmHg、(1.03±0.06)分比(1.35±0.09)分,治疗14 d后:(332±14)mmHg比(305±16)mmHg、(0.92±0.04)分比(1.22±0.12)分](均P<0.05);2组病死率及不良反应发生率差异无统计学意义(P>0.05)。急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分是影响早期脓毒症相关ARDS患者28 d生存率的因素(P<0.05);氢化可的松治疗并不会提高患者的28 d生存率(P>0.05)。结论    氢化可的松治疗早期脓毒症相关ARDS可以提高患者氧合指数,降低肺损伤,但不能提高患者的生存率。APACHE Ⅱ评分是影响脓毒症相关ARDS患者28 d生存率的因素。

  • Clinical effect of hydrocortisone on early sepsis-related acute respiratory distress syndrome

    Fang Ge, Song Genhong, Lin Xiaoyan

    Intensive Care Unit, Yan′an University Affiliated Hospital, Shaanxi Province, Yan′an 716000, China

    Corresponding author: Lin Xiaoyan, Email: 63695808@qq.com

    AbstractObjective    To analyze the clinical effect of hydrocortisone on early sepsis-related acute respiratory distress syndrome(ARDS). Methods    Totally 80 patients with early sepsis-related ARDS were enrolled in Yan′an University Affiliated Hospital from January 2010 to December 2015; they were equally allocated to have hydrocortisone(50 mg/time, 1 time/6 h, for 7 d) and placebo(0.9% sodium chloride). Oxygenation index, score of lung injury and death were recorded. Influence factors of 28 d survival rate were analyzed by logistic regression. Adverse reactions were observed. Results    Tidal volume in hydrocortisone group was significantly lower than that in placebo group(P=0.04); other basic clinical data had no significant differences between groups(P>0.05). Oxygenation index in hydrocortisone group was significantly higher and score of lung injury was significantly lower than that in placebo group 1-7 d and 14 d after treatment[1 d: (226±12)mmHg vs (192±11)mmHg, (1.82±0.23)points vs (2.26±0.65)points; 7 d: (313±15)mmHg vs (289±15)mmHg, (1.03±0.06)points vs (1.35±0.09)points; 14 d: (332±14)mmHg vs (305±16)mmHg, (0.92±0.04)points vs (1.22±0.12)points](P<0.05). Death rate and adverse reaction rate had no significant differences between groups(P>0.05). Logistic regression analysis showed that score of the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) was a risk factor of 28 d survival rate in patients with early sepsis-related ARDS(P<0.05); hydrocortisone had no protective effect on 28 d survival(P>0.05). Conclusions    Hydrocortisone treating early sepsis-related ARDS can improve oxygenation index and reduce lung injury but not increase survival rate. The APACHE Ⅱ score is an influence factor of 28 d survival rate in patients with sepsis-related ARDS.

    Key words】Sepsis-related acute respiratory distress syndrome;Hydrocortisone


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