糖皮质激素治疗感染性休克的疗效

Effect of low-dose glucocorticoids in septic shock

目的探讨小剂量糖皮质激素对纠正感染性休克和改善患者预后的作用。方法对2000年1月至2006年10月收治于首都医科大学宣武医院ICU的46例感染性休克患者进行回顾性研究。2000年1月至2002年10月收治的24例患者未接受糖皮质激素治疗，为对照组（n=24）；2002年11月至2006年10月收治的22例患者接受了糖皮质激素治疗，为治疗组（n=22）。除糖皮质激素应用外，两组患者在其他治疗方法上无明显差别。比较两组患者在纠正休克和转归方面的差异。结果治疗组（72．73）在治疗第7天时休克纠正比率明显高于对照组（41．67）（P〈0．05）。治疗组治疗48～72h后CRP明显低于对照组[（20．05±4．06）mg/dl vs．（23．55±4．93）mg/dl]，而治疗3d后APACHEⅡ也低于对照组[（16．76±4．87）vs．（21．45±4．02）]。而两组患者在呼吸机治疗时间、住ICU时间、MODS发生率和死亡率方面差异无统计学意义（P〉0．05）。结论对顽固性感染性休克患者应用小剂量糖皮质激素可有效地纠正休克，更早地撤离血管活性药物，并明显降低炎症反应程度，但其对患者的远期预后影响值得进一步研究。

Objective To study retrospectively the effects of low-dose glucocorticoids in outcomeof septic shock. Method The present study was carried out by analysis of septic shock patients treated with norepinephrine or dopamine. A total of 46 patients with a confirmed diagnosis of septic shock admitted from January 2000 to October 2006 were divided into two groups： （1）glucocorticoids treatment group （n = 22）, treated with glucocorticoids in addition to conventional treatment from November 2002 to October 2006; （2） control group （ n = 24）, only treated with routine treatment from January 2000 to October 2002. The differences in outcome were compared between the two groups. Results The duration of of vasopressor support was significantly shorter in treatment group compared with control group. The percentage of shock reversal at 7 days was higher in treatment group than that in control group （72.73% vs. 41.67%, P = 0.034）. Furthermore, a reduction in C-reactive protein（CRP） indicated inhibition of inflammatory response due to the effect of glucocorticoids in treatment group within 48-72 hours from admission to ICU（20.05 ± 4.06 mg/dl vs. 23.55± 4.93 mg/dl, P = 0.015）. Therefore, APACHEⅡ score on 3^rd day was significantly lower in treatment group than that in control group（ 16.76 ± 4.87 vs. 21.45 ± 4.02, P = 0. 001）. However, there were no statistical significanees in the duration of mechanical ventilation, the length of ICU stay, the incidence of multiple organ dysfunction syndrome （MODS） and hospital-mortality between the two groups （P 〉 0.05）. Conclusions Treatment with low-dose glucocorticoids could effectively accelerate the recovery from refractory septic shock and the early withdrawal of vasopressor. It seems to be associated with the reduced production of CRP, suggesting the effects of low-dose glucocorticoids on both stabilization of hemodynamics and inhibition of inflammatory response. The beneficial effects of low-dose steroids regimens on long-term outcome of patients with septic shock have not determined.