小剂量糖皮质激素联合垂体后叶素治疗感染性休克的疗效观察

Efficacy of Low Dose Glucocorticoid and Vasopressin in Treatment of Septic Shock

目的研究小剂量糖皮质激素联合垂体后叶素治疗感染性休克的疗效。方法选取2013年4月至2014年9月北京市大兴区人民医院重症医学科收治的66例感染性休克患者,按照随机数表法将患者分为观察组（33例）和对照组（33例）。对照组采取垂体后叶素治疗,按照0.01-0.1 U/min的标准给药,最终目的是使平均动脉压处于65-70 mmHg（1 mmHg=0.133 kPa）内,观察组患者在此基础上给予氢化可的松50 mg,在每隔6 h进行1次静脉滴注。比较两组患者在治疗后不同时间点的内生肌酐清除率和血乳酸水平变化情况,观察两组患者的不良反应状况、ICU住院时间和垂体后叶素的使用时间。结果两组治疗前,治疗后1、2、3 d内生肌酐清除率呈逐渐上升趋势,但观察组上升幅度更大[观察组：（34±5）,（57±11）,（72±12）,（87±15）m L/min;对照组：（35±5）,（42±8）,（51±8）,（59±11）m L/min];两组血乳酸均呈逐渐下降趋势,但观察组下降幅度更大[观察组：7.5±1.1）,（4.1±1.3）,（3.4±0.8）,（2.3±0.2）mmol/L;对照组：（7.2±1.3）,（6.8±1.4）,（4.7±1.3）,（3.6±0.7）mmol/L],两组在组间、不同时点间以及组间·不同时点间交互作用差异均有统计学意义（P〈0.05）。观察组低钠血症发生率显著低于对照组[3.0%（1/33）比27.3%（9/33）,P〈0.01],ICU住院时间和垂体后叶素的使用时间显著短于对照组[（10.1±0.7）d比（24.3±7.8）d,（7.2±1.3）d比（14.3±4.1）d],差异有统计学意义（P〈0.01）。结论小剂量糖皮质激素联合垂体后叶素治疗感染性休克患者,能明显升高内生肌酐清除率,还能降低血乳酸水平,缩短患者的ICU住院时间和垂体后叶素的使用时间,不良反应率较低,其疗效良好,值得广泛推广使用。

Objective To study the therapeutic effect of low-dose glucocorticoid and vasopressin in treatment of septic shock. Methods Total of 66 patients with septic shock admitted to the ICU of People＇ s Hospital of Beijing Daxing District from Apr. 2013 to Sep. 2014 were included and divided into observation group（ 33 cases） and control group（ 33 cases） according to the random number table method. The control group received vasopressin treatment,0. 01-0. 1 U / min standard administration,with the aim of achieving mean arterial pressure in the range of 65-70 mmHg（ 1 mmHg = 0. 133 kPa）,the observation group was given hydrocortisone on the basis the control group＇s treatment50 mg,1 intravenous infusion every 6 h. The creatinine clearance and blood lactate level after treatment at different time points were compared,the adverse reactions in the situation,ICU stay length and vasopressin using time were observed. Results Before treatment,creatinine clearance in the two groups showed a gradual upward trend,but the rise range was bigger rise in the observation group[observation group：（ 34 ± 5）,（ 57 ± 11）,（ 72 ± 12）,（ 87 ± 15） m L / min; control group：（ 35 ± 5）,（ 42 ± 8）,（ 51 ± 8）,（ 59 ± 11） m L / min ]; both groups showed decreased blood lactate trend,but the decline range was bigger in the observation group[observation group：（ 7. 5 ± 1. 1）,（ 4. 1 ±1. 3）,（ 3. 4 ± 0. 8）,（ 2. 3 ± 0. 2） mmol / L; control group：（ 7. 2 ± 1. 3）,（ 6. 8 ± 1. 4）,（ 4. 7 ± 1. 3）,（ 3. 6 ± 0. 7） mmol/L],between the two groups,different time points and the interaction between groups·time points the differences were statistically significant（ P〈0. 05）. The hyponatremia adverse reaction rate of the observation group was significantly lower than the control group[3. 0%（ 1 /33） vs 27. 3%（ 9 /33）,P〈0. 01],ICU stay time and vasopressin use time of the observation group was significantly shorter than the control group[（ 10. 1 ± 0. 7） d vs（ 24. 3 ± 7. 8） d,（ 7. 2 ± 1. 3） d vs（ 14. 3 ± 4. 1） d],the difference was statistically significant（ P〈0. 01）. Conclusion The low-dose glucocorticoid and vasopressin treatment of septic shock can significantly increase creatinine clearance rate,reduce blood lactate levels,shorten ICU stay and the total vasopressin using time,with low adverse reaction rate,therefore is defined as good efficacy,and worth of wide application.