小剂量氢化可的松对顽固性感染性休克患者去甲肾上腺素使用率及乳酸清除率的影响

The effect of low-dose hydrocortisone on requirement of norepinephrine and lactate clearance in patients with refractory septic shock

目的观察小剂量氢化可的松对顽固性感染性休克患者去甲肾上腺素使用率和乳酸清除率的影响，探讨补充应激剂量皮质醇激素逆转感染性休克和改善组织氧供的作用。方法选择经充分液体复苏后仍需去甲肾上腺素维持血压的顽固性感染性休克患者77例，随机双盲分为两组，治疗组在对照组治疗基础上静脉注射小剂量氢化可的松，疗程14d。比较两组治疗过程中去甲肾上腺素使用情况及平均动脉压（MAP）和乳酸清除率的变化。结果两组患者在治疗24h、7d、14d去甲肾上腺素使用率均较治疗即刻明显降低，MAP明显升高（P均〈0．01）。治疗组治疗7d时去甲肾上腺素使用率明显低于对照组，且去甲肾上腺素使用时间较对照组缩短（P均〈0．05）；在治疗24h、7d时MAP、乳酸清除率较对照组明显升高（P〈0．05或P〈0．01）。两组患者病死率和重症监护病房（ICU）住院天数比较无显著差异。结论针对伴有顽固性低血压的感染性休克患者，小剂贯应用氢化可的松可缩短缩血管药物的应用时间，减少缩血管药物的用量，改善组织氧供，从而更快地逆转休克状态。

Objective To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply. Methods Seventyseven septic shock patients with hypotension refractory to fluids and administration of norepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure （MAP）, lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment. Results The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups （all P〈0.01）. Compare to the control group, the course of using norepinephrine was shorter and the number of using norepinephrine was smaller in 7 days in treatment group （both P〈0.05） ; the MAP and lactate clearance were higher in 24 hours and 7 days in treatment group （P〈0. 05 or P〈0. 01）. But there were no differences in mortality and the length of stay in intensive care unit （ICU）. Conclusion For the patients with septic shock with refractory hypotension, low-dose hydrocortisone can decrease the time course and dosage of vasopressors, improve tissue oxygen supply, thus can reverse septic shock more rapidly.