短程甲强龙冲击疗法在创伤合并肺挫伤早期治疗的研究

Clinical study of short term high-dose Methylprednisolone in thoracic trauma emergency treatment

目的探讨短程大剂量甲强龙在创伤合并肺挫伤的治疗效果及可能机制。方法回顾分析2005年1月～2005年12月收治的43例严重肺挫伤患者的诊断与治疗。29例为肺挫伤后前3d连续每天应用大剂量甲强龙(30mg/kg)治疗组,14例为未应用激素的对照组。观察肺挫伤伤后2～6h、24h、5d、14d临床变化、病程天数、死亡率、影像学结果和PO2/FiO2值的变化。结果肺挫伤后24h病情发展至高峰,之后逐渐恢复,治疗组24hPO2/FiO2值为(127.18±8.39),高于对照组(P<0.05),临床症状相对较轻,伤后5dPO2/FiO2值接近正常组,CT显示肺部渗出大部吸收,肺结构恢复正常,对照组延后至伤后14d恢复正常,治疗组病程为(21±1.53)d,死亡率10.3%;对照组病程(34.75±2.5)d(P<0.01)死亡率35.7%。结论肺挫伤临床病程是个复杂而有序的过程,早期大剂量甲强龙治疗可能通过调理炎症反应,减轻肺水肿等机制抑制严重肺挫伤强烈的自我损伤,达到防治ARDS的目的。临床使用,可明显提高抢救成功率,缩短病程。

[Objective] To analyze the effect of early high doses Methylprednisolone treatment on pulmonary contusion combined with other multiple system organ injury. [Methods] A retrospective analysis of 43 patients with pulmonary contusion from January 2005 to December 2005 in our hospital, most of who were multitraumatized for 29 Methylprednisolone （30 mg/kg） treated patients compared to 14 nonsteroid patients. Clinical situation, time of therapy, imageologic manifestation and PO2/FiO2 value was assessed at 2-6 h, 24 h, 5 days and 7 days after injury. [Resuits] State of illness was severely aggravated at 2-6 h to 24 h postcontusion then became better. PO2/FiO2 value of Methylprednisolone treated patients was descreased at 24 h, then returned toward normal by 5 days, While, PO2/FiO2 value of nonsteroid patients was decreased more severely than former Methylprednisolone treated group （P 〈0.05）, and needed more time to recovery over 14 days, which was consisted with other results. [Conclusions] Methylprednisolone-treated patients has significantly reduced lung injury based on inflammation adjustment and pulmonary edema inhibition, ARDS can be prevented effectively, Methylprednisolone can decrease mortality in lung contusions emergency therapy.