小剂量氢化可的松琥珀酸钠对腹部手术感染性休克患者的临床疗效评价

Clinical Efficacy of Small Dosage of Hydrocortisone Sodium Succinate in Abdominal Surgery Patients with Septic Shock

目的:评价小剂量氢化可的松琥珀酸钠在治疗腹部手术后感染性休克患者的临床疗效。方法:选取2011年6月—2014年12月间确诊行腹部手术后感染性休克患者46例,将其随机分为观察组和对照组各23例,对照组患者围手术期给予常规处理,观察组患者在对照组患者治疗基础上加用氢化可的松琥珀酸钠100 mg治疗;评价两组患者治疗前后乳酸水平、乳酸清除率、APACHEⅡ评分值及患者休克恢复时间、ICU停留时间、不良反应的发生率和28 d病死率等临床疗效情况。结果:治疗前,两组患者乳酸浓度和APACHEⅡ评分值经比较其差异无统计学意义(P>0.05);治疗24 h、48 h后,观察组患者乳酸清除率为(46.2±8.1)%和(64.6±15.3)%均显著高于对照组为(30.1±7.9)%和(48.2±8.7)%,两组患者APACHEⅡ评分值均较治疗前显著下降且观察组治疗后显著低于对照组,差异均有统计学意义(P<0.05);观察组患者休克恢复时间(3.8±1.5)d和ICU停留时间(12.3±3.1)d均短于对照组(5.2±2.4)d和(19.2±4.3)d(P<0.05);前者28 d病死率为13.04%显著小于对照组为47.83%(P<0.05);两组患者不良反应的发生率经比较其差异无统计学意义(P>0.05)。结论:小剂量氢化可的松琥珀酸钠给予腹部手术患者术后感染性休克的治疗是安全的和有效的。

Objective： To evaluate the clinical efficacy of small dosage of hydrocortisone sodium succinaie in abdominal surgery patients with septic shock. Methods： Forty-six patients with septic shock after abdominal surgery from June 2011 to December 2014 in our hospital were randomly divided into two groups; 23 patients in the control group were treated with routine perioperative treatment and the observation group received hydrocortisone sodium suc- cinate 100 mg on the basis of conventional treatment. The lactate levels, lactate clearance, APACHE 1] shock score and patient recovery time, ICU stay time, efficacy clinical situation, the incidence of adverse reactions and 28 d mortality were observed and compared before and after treatment. Results： Lactate concentration difference of the two groups of patients before treatment was not statistically significant（P〉0.05）, APACHE 1] score difference of the two groups of pa- tients before treatment was not statistically significant（P〉0.05）. After the treatment of 24 h and 48 h, lactate clearance rates of the observation group were （46.2±8.1）% and （30.1±7.9）%, significantly higher than those in the treatment groups which were （64.6± 15.3）% and （48.2±8.7）%. APACHE II score significant decline in the observation group be- tbre and after treatment was significantly lower than treatment and these differences were statistically significant （P〈 0.05）. Recovery time and ICU stay time of the observation group as （3.8~1.5）d and （5.2~=2.4）d shorter than those in the control group, （ 12.3±3.1）d and （19.2±4.3）d, the difference was statistically significant（P〈0.05）, 28 d mortality was sig- nificantly lower than that of the control group and the difference was statistically significant（P〈0.05）. Incidences of ADR of the two groups has no significant difference（P〉0.05）. Conclusion： Small dosage of hydrocortisone sodium succinate is safe and effective for abdominal surgery patients with septic shock.