早期应用小剂量甲基泼尼松龙救治ARDS合并感染性休克患者的临床分析

Clinical analysis for the early and low-dose administration of corticosteroids in treating patients with acute respiratory distress syndrome complicated by septic shock

目的探讨早期应用小剂量甲基泼尼松龙治疗急性呼吸窘迫综合征(ARDS)的价值。方法比较39例ARDS合并感染性休克患者应用非甲基泼尼松龙治疗(A组)与甲基泼尼松龙治疗(B组)的各项临床指标。结果治疗后A组死亡12例,病死率为63.2%;B组死亡11例,病死率为55.0%,2组差异无统计学意义(P>0.05);A组休克纠正5例(26.3%),B组11例(55.0%),2组比较差异有统计学意义(P<0.05)。PaO2/FiO2比较,2组治疗后与治疗前比较均提高,差异有统计学意义(P<0.05,P<0.01)。2组治疗24h比较差异无统计学意义(P>0.05),治疗第3天、第7天,B组高于A组,差异有统计学意义(P<0.01,P<0.05);结论早期小剂量应用甲基泼尼松龙能协同常规治疗纠正ARDS患者的缺氧和休克,应用于合并感染性休克患者可为原发病治疗赢得时间与机会。

Objective To observe the therapeutic effect of early and low-dose administration of corticosteroids on acute respiratory distress syndrome （ARDS） complicated by septic shock.Methods 39 patients with ARDS complicated by septic shock were enrolled in the study. The patients in group A were treated by non-corticosteroids, the patients in group B were treated by early and low-dose corticosteroids,The clinical data in both groups were collected and analyzed.Results After treatment the mortality was 63.2% （12 cases） in group A,whichwas 55.0% （11 ca ses） in group B,there was no significant difference between two groups（ P 〉 0.05）;the improvement rate for shock was 26.3% （5 cases） in group A,which was 55.0% （11 cases） in group B,there was a significant difference between two groups（ P 〈 0.05）.The PaO2/FiO2 was significantly increased in both groups after treatment, as compared with that before treatment （ P 〈0. 05 or P 〈 0.01 ）. There was no significant difference 24h after treatment between two groups（ P 〉 0.05） ,but the ratio at the 3rd and 7th day in group B was signifcandy higher than that of group A （P 〈 0.01 or P 〈 0.05）. Conclusion Early and low-dose administration of corticosteroids combined with routine therapy can improve patients＇ oxygen lack and shock, and can gain the chance for treating primary diseases in patients with ARDS complicated by septic shock.