糖皮质激素在重症医学科急性呼吸窘迫综合征中的应用

Glucocorticoids in treatment of patients with acute respiratory distress syndrome in intensive care unit

目的评价糖皮质激素(glucocorticoids,GCs)在重症监护室(intensive care unit,ICU)治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)中的作用。方法回顾性分析本院入住ICU的ARDS患者的临床资料,并根据致病因素在肺损伤中的作用,将所入选患者分为肺内源性ARDS(primarily from pulmonary diseases,ARDSp)和肺外源性ARDS(primarily from extra-pulmonary diseases,ARDSexp);ARDSp患者62例,ARDSexp患者101例。根据GCs的使用量各分为3组,分析ARDSp及ARDSexp应用GCs和未应用GCs患者的病情改善和病死率。结果 ARDSp及ARDSexp患者各组急性生理与慢性健康评分(Acute Physiology and Chronic Health EvaluationⅡ,APACHE-Ⅱ)相当(P>0.05)。GCs治疗<30mg/d组与≥30mg/d组比较,病情改善时间和呼吸机治疗时间明显缩短(P<0.01),病死率也略低(P>0.05);GCs治疗<30mg/d组与非GCs治疗组比较差异有统计学意义(P<0.01);≥30mg/d组与非GCs治疗组比较差异无统计学意义(P>0.05)。ARDS患者总体病死率23.3%(38/163),其中使用GCs治疗组病死率22.8%(34/149),未使用GCs治疗组病死率28.6%(4/14)(P>0.05)。结论低剂量(<30mg/d)、早期应用(24h内)、长期疗程(>7d)的GCs,可及时遏制炎性介质的"瀑布样效应",在一定程度上缩短病程,降低病死率。

Objective To evaluate the effect of glucocorticoids （GCs ） in treatment of patients with acute respiratory distress syndrome （ARDS ） in intensive care unit （ICU ）.Methods The clinical data were analyzed retrospectively from ARDS patients admitted to the ICU.In accordance with the role of virulence factors in lung injury, all the cases were divided into two large groups,patients with pulmonary ARDS group （ARDSp group）and patients with extrapulomonary ARDS group （ARDSexp group）,ARDSp group had 62 cases and the other group had 101 cases. Then,the patients were subdivided into three smaller groups according to the dosage of GCs.Finally,the disease conditions and death rates among groups were analyzed.Results General conditions including Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE-Ⅱ）scores were similar between the two groups （P〉0.05）.The GCs 〈30 mg/d group showed a shorter time of improvement in patients ’ general condition and the days with mechanical ventilation support than those of the GCs≥30 mg/d group（P〈0.01）,and the death rate reduced slightly（P〉0.05）. The overall death rate of ARDS group was 23.3%（38/163）.In GCs-use group,the rate was 22.8%（34/149）,and in non GCs-use group,it was 28.6%（4/14）（P〉0.05）.Conclusion This research suggests that early therapy（〈24 h）, low dose（〈30 mg/d）and long treatment GCs （〉7 d）could help reverse serious inflammatory reaction,improve clinical symptoms and decrease death rate.