甲基强的松龙对严重肺挫伤患者炎性细胞因子的影响(附65例分析)

Effect of Methylprednisolone on inflammatory cytokine in patients with severe pulmonary contusion:Analysis of 65 cases

目的观察甲基强的松龙对严重肺挫伤患者炎性细胞因子的抑制作用和临床疗效,确定其合适剂量。方法65例严重肺挫伤随机分为三组,即小剂量组(A组,n=22,甲基强的松龙针80 mg/d),中等剂量组(B组,n=22,甲基强的松龙针500 mg/d),大剂量组(C组,n=21,甲基强的松龙针1 000 mg/d),治疗期3天,检测入院后治疗前、第4天、第7天血清细胞因子TNF-α、IL-6水平,并观察临床疗效。结果B、C两组中TNF-α在治疗第4天始,IL-6在第7天始受到明显抑制,较A组同期有显著下降;B、C两组与A组比较血气分析指标改善,ARDS发生率明显降低,机械通气时间显著缩短;B、C两组间比较各指标无显著差异。结论早期应用中等剂量甲基强的松龙对严重肺挫伤具有良好疗效,可显著抑制机体炎症介质的产生,但更高剂量的甲基强的松龙未见临床疗效的进一步改善。

Objective To evaluate the effect of methylprednisolone on inflammatory cytokine and clinical outcome in patients with severe pulmonary contusion and to find out the better dosage of it for those patients. Methods Sixty-five patients with severe pulmonary contusion were randomized to receive intravenous methylprednisolone for three days at one of the following dosages： （1） low, 80 mg/d, n=22; （2） medium, 500 mg/d, n=22; （3） high, 1 000 mg/d, n=21. The serum levels of TNF-α and IL-6 were measured on admission and on the 3rd, 7th day. Results The serum levels of TNF-α and IL-6 were reduced more significantly after treatment both in the high and medium dosages groups than those in the low dosage group; in these tWO groups, PaO2 and PaO2/FiO2 improved significantly, the total duration of assisted ventilation was less and the inci- dence of ARDS was lower than those in the low one. There were no significant differences in all indexes between the high and medium dosage group. Conclusion The early administration of medium dosage of methylprednisolone can play an important role in the treatment of severe lung contusion, which significantly inhibits the production of inflammatory cytokine, but there is no more beneficial in the treatment with higher dosage of it.