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糖皮质激素治疗早期重型肝炎最佳方案初探 被引量:22

Investigation of optimum Plan of Glucocorticoids in the Treatment of Patients With Early Severe Hepatitis
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摘要 目的观察糖皮质激素不同给药方式治疗早期重型肝炎的临床疗效和副作用,初步探讨糖皮质激素治疗早期重型肝炎的最佳方案。方法将68例早期重型肝炎患者随机分为3组即5 mg地塞米松组27例、10mg地塞米松组21例及对照组20例。5 mg地塞米松组:27例患者在综合治疗的基础上,使用小剂量地塞米松5mg,间断给药,待血清总胆红素下降到100μmol/L停用激素;10 mg地塞米松组:21例早期重型肝炎患者,采用地塞米松10 mg/天静脉滴注,使用一周后,开始逐渐减量至停药;对照组20例仅采用综合治疗。观察3组治疗前后临床表现、血清总胆红素(TBil)及凝血酶原时间(PT)的变化以及每组药物的副作用和并发症的情况。结果治疗6周后与对照组比较,治疗组患者血清总胆红素明显降低及凝血酶原时间缩短(P<0.01),临床症状明显好转,两个治疗组的有效率明显优于对照组(P<0.01)。5 mg地塞米松组的继发感染、消化道出血、肝性脑病、肝肾综合征等并发症比10 mg地塞米松组和对照组明显减少(P<0.05),住院时间也明显缩短(P<0.01)。结论小剂量激素,间隔用药治疗早期重型肝炎,疗效明显,病程缩短,副作用小。 Objective To observe the clinical efficacy of different administration ways of glucocorticoids in the treatment of patients with early stage of severe hepatitis and to investigate optimum plan. Methods 68 patients with early stage of severe hepatitis were randomly divided into three groups.27 cases in treatment group A were administrated low dose dexamethasone 5mg in an interval of 48-72 hours to synthetic treatment.21 patients in treatment group B received the synthetic treatment plus 10mg dexamethasone every day for a week,then the dose of dexamethasone began to reduce gradually untill total bilirubin obviously decreased,while 20 cases in control group only received the synthetic treatment.The changes of clinical symptoms,the serum total bilirubin(TBil) and the prothrombin time(PT) in the three groups were observed before and after therapy.The side effect and complication of each group were monitored. Results After 6 weeks treatment,compared with control group,the two treatment groups can significantly decrease the level of TBil and PT(P〈0.05),and improve the clinical symptoms.The success rate of two treatment groups surpass the control group(P〈0.05).The complications of secondary infection,alimentary tract hemorrhage,hepatorenal syndrome(HRS),hepatic encephalopathy(HE) occur in control group and treatment group B more than that in treatment group A(P〈0.05).In-hospital time become shorter in treatment group A than in other groups. Conclusion The administration of low dose clycocorticosteroid to the early severe hepatitis had obvious effect,short course of disease and slighter side-effect.
出处 《南华大学学报(医学版)》 2010年第1期80-83,共4页 Journal of Nanhua University(Medical Edition)
基金 衡阳市科学技术局科技计划项目(项目号:2009KJ40)
关键词 糖皮质激素 重型肝炎 治疗 glucocorticoids severe hepatitis treatment
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