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

  【Abstract】Objective    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