糖皮质激素在重症社区获得性肺炎致急性呼吸窘迫综合征综合救治中的应用价值

Application Value of Glucocorticoid for Comprehensive Treatment of Acute Respiratory Distress Syndrome Induced by Serious Community Acquired Pneumonia

目的探讨糖皮质激素在重症社区获得性肺致急性呼吸窘迫综合征治疗中的应用价值。方法选择我院2008年1月至2013年1月收治的46例重症社区获得性肺致急性呼吸窘迫综合征患者为研究对象,随机分为两组各23例。对照组患者采取脱水、抗感染、营养支持等常规治疗,观察组患者在对照组基础上加以糖皮质激素治疗,对两组的治疗效果、治疗后血清指标等进行比较。结果观察组治疗总有效率为82.61%,对照组为65.22%,两组比较差异无统计学意义(P>0.05);观察组治疗后ET-1、IL-1β、IL-6、CRP、TNF-α水平明显低于对照组,差异有统计学意义(P<0.05);观察组机械通气时间、住院时间明显短于对照组,氧合指数明显高于对照组,两组比较差异有统计学意义(P<0.05)。结论糖皮质激素协助治疗能有效改善临床症状,缩短机械通气时间,提高临床救治成功率,值得进一步推广应用。

Objective To explore the clinical value of glucocorticoid for treatment of acute respiratory distress syndrome induced by serious community acquired pneumonia. Methods Forty-six patients with acute respiratory distress syndrome induced by serious community acquired pneumonia admitted to our hospital from January 2008 to January 2013 were selected as the research objects and randomly divided into two groups, with 23 cases in each group. Patients in the control group were given routine therapy, while patients in the observation group were given glucocorticoid therapy on the basis of routine therapy. The curative effect and serum indices were observed and compared after therapy. Results The total effective rates of the observation group and the control group were 82.61% and 65.22% respectively, without significant difference（P〈0.05）. The serum ET-1, IL-1β, IL-6, CRP and TNF-α after therapy of the observation group were significantly lower than those of the control group（P〈0.05）. The duration of mechanical ventilation and length of hospital stay of the observation group were significantly shorter than those of the control group, and the oxygenation index of the observation group was significantly higher than that of the control group（P〈0.05）. Conclusions Glucocorticoid for assist treatment of acute respiratory distress syndrome induced by serious community acquired pneumonia can effectively improve clinical symptoms, shorten duration of mechanical ventilation, and improve success rate of treatment, which is worthy of clinical promotion.