2021 年第 9 期 第 16 卷

糖皮质激素对脓毒性休克患者免疫功能和血流动力学及临床疗效的影响

Effect of glucocorticoid on immune function, hemodynamics and clinical efficacy in patients with septic shock

作者：黄鑫波明静王勇湘齐佳陈功灵刘端绘

英文作者：Huang Xinbo Ming Jing Wang Yongxiang Qi Jia Chen Gongling Liu Duanhui

单位：广西壮族自治区梧州市红十字会医院重症医学科543002

英文单位：Department of Critical Care Wuzhou Red Cross Hospital Guangxi Zhuang Autonomous Region Wuzhou 543002 China

关键词：脓毒性休克；糖皮质激素；免疫功能；血流动力学；临床疗效

英文关键词：Septicshock;Glucocorticoid;Immunefunction;Hemodynamics;Clinicalefficacy

• 摘要：

• 目的 探讨糖皮质激素对脓毒性休克患者免疫功能、血流动力学及临床疗效的影响。方法 选取2017年6月至2020年8月广西壮族自治区梧州市红十字会医院收治的80例脓毒性休克患者，根据随机数字表法将其分为对照组和观察组，各40例。2组患者均接受常规治疗，观察组在此基础上应用氢化可的松静脉滴注，均连续治疗7 d。比较2组临床疗效，治疗前后免疫功能、血流动力学指标、心肌肌钙蛋白I（cTnI）、B型脑钠肽（BNP）水平及机械通气时间、重症监护病房（ICU）住院时间、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、28 d死亡率。结果 观察组总有效率高于对照组［95.0%（38/40）比75.0%（30/40）］（χ2=8.162, P=0.001）。2组治疗前后CD+4、CD+8、CD+4/CD+8比值比较，差异均无统计学意义（均P＞0.05）。治疗后，2组平均动脉压、中心静脉压水平均高于治疗前，且观察组均高于对照组［（117±9）mmHg（1 mmHg=0.133 kPa）比（98±8）mmHg、（15.4±1.7）mmHg比（13.1±1.4）mmHg］，心率、血乳酸水平均低于治疗前，且观察组均低于对照组［（86±4）次/min比（98±6）次/min、（2.9±0.9）mmol/L比（3.9±0.9）mmol/L］（均P＜0.05）。治疗后，观察组cTnI、BNP水平均低于治疗前，且低于对照组，差异均有统计学意义（均P＜0.05）。观察组机械通气时间、ICU住院时间均短于对照组，治疗后APACHEⅡ评分低于对照组，差异均有统计学意义（均P<0.05）。2组28 d死亡率、不良反应发生率比较，差异均无统计学意义（均P＞0.05）。结论 糖皮质激素对脓毒性休克患者疗效显著，能有效改善血流动力学，降低心肌损伤，且对机体免疫功能无明显影响，安全性较高。

• Objective To investigate the effect of glucocorticoid on immune function, hemodynamics and clinical efficacy in patients with septic shock. Methods From June 2017 to August 2020, 80 patients with septic shock admitted to Wuzhou Red Cross Hospital, Guangxi Zhuang Autonomous Region were selected. Patients were randomly divided into control group and observation group, with 40 cases in each group. Both groups of patients were given conventional treatment, and the observation group was treated with hydrocortisone intravenous drip based on conventional treatment. Both groups were treated for 7 d. The clinical efficacy, immune function, hemodynamic parameters, cardiac troponin I (cTnI), brain natriuretic peptide (BNP) levels before and after treatment, mechanical ventilation time, length of intensive care unit(ICU) stay, acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) score, and 28 d mortality were compared between the two groups. Results The total effective rate of observation group was higher than that of control group ［95.0%(38/40) vs 75.0%(30/40)］(χ2=8.162, P=0.001). There were no significant differences in CD+4, CD+8, and CD+4/CD+8 before and after treatment between the two groups(all P>0.05). After treatment, levels of mean arterial pressure and central venous pressure of both group were higher than those before treatment, and those of observation group were higher than those of control group［(117±9)mmHg vs (98±8)mmHg,(15.4±1.7)mmHg vs (13.1±1.4)mmHg］; levels of heart rate and serum lactic acid of both groups were lower than those before treatment, and those of observation group were lower than those of control group［(86±4)times/min vs (98±6)times/min,(2.9±0.9)mmol/L vs (3.9±0.9)mmol/L］(all P<0.05). After treatment, levels of cTnI and BNP of both groups were lower than those before treatment, and those of observation group were lower than those of control group(all P<0.05). The mechanical ventilation time and length of ICU stay of observation group were shorter than those of control group, and the APACHE Ⅱ score after treatment of observation group was lower than that of control group (all P<0.05). There were no significant differences in 28 d mortality and the incidence of adverse reactions between the two groups(both P>0.05). Conclusions Glucocorticoid has significant effect on patients with septic shock. It can effectively improve hemodynamics, reduce myocardial injury, and has no significant effect on body′s immune function, with high safety.