氢化可的松琥珀酸钠给药方式差异对重症脓毒血症继发休克患者生命体征、动态血糖指标及死亡率的影响

Influence of different administration methods of Hydrocortisone Sodium Succinate on vital signs, dynamic glycemic indexes and mortality of severe sepsis patients with secondary shock

目的探讨氢化可的松琥珀酸钠静脉滴注与微量泵注给药对重症脓毒血症继发休克患者生命体征、动态血糖指标及死亡率的影响。方法选取该院2014年6月-2016年6月收治重症脓毒血症继发休克患者共100例。采用随机数字表法分为A组(50例)和B组(50例),在常规对症干预基础上分别给予氢化可的松琥珀酸钠静脉滴注与微量泵注给药。比较两组患者休克持续时间、ICU住院时间、总住院时间、28 d死亡率、治疗前后生命体征指标、治疗后血乳酸清除率和动态血糖监测指标水平。结果两组患者休克持续时间,ICU住院时间及总住院时间比较差异无统计学意义(P>0.05);两组患者28 d内死亡率比较差异无统计学意义(P>0.05);两组患者治疗前后HR、MAP及CVP水平组间比较差异无统计学意义(P>0.05);两组患者治疗后6、24及48 h血乳酸清除率比较差异无统计学意义(P>0.05);两组患者平均血糖值(MBG)水平比较差异无统计学意义(P>0.05);但B组患者最大血糖波动幅度(LAGE)、血糖波动系数(GV)及高血糖时间窗水平均低于A组(P<0.05)。结论氢化可的松琥珀酸钠2种给药方式治疗重症脓毒血症继发休克临床疗效相当,但微量泵注给药方式应用可有效提高血糖稳定性,维持机体代谢平衡。

Objective To investigate the influence of different administration methods including intravenous infusion and micro pump of Hydrocortisone Sodium Succinate （HSS） on vital signs, dynamic glycemic indexes and mortality of severe sepsis patients with secondary shock. Methods One hundred patients of severe sepsis with secondary shock treated from June 2014 to June 2016 were chosen and randomly divided into group A （50 patients） with intravenous infusion of HSS and group B （50 patients） with HSS administration by micro pump. Duration of shock, ICU stay time and total hospitalization time, 28 -d mortality, vital signs before and after treatment, blood lactate clearance rate and dynamic blood glucose monitoring indexes after treatment were compared between both groups. Results There was no significant difference in the duration of shock, the ICU stay time, the hospitalization time or the 28-d mortality between the two groups （P 〉 0.05）. There was no significant difference in HR, MAP or CVP before and after treatment between the two groups （P 〉 0.05）. There was no significant difference in the blood lactate clearance rate in 6, 24 and 48 h after treatment between the two groups （P 〉 0.05）. There was no significant difference in the level of MBG between the two groups （ 〉 0.05）. But the levels of LAGE, GV and high blood glucose time window of the group B were significant lower than those of the group A（ 〈 0.05）. ConclusionsIntravenous infusion and micro pump administration of Hydrocortisone Sodium Succinate possess the same clinical effect in the treatment of severe sepsis with secondary shock. However, micro pump administration can efficiently improve the stability of blood glucose and maintain the metabolic balance of the body.