甲泼尼龙琥珀酸钠注射剂治疗呼吸窘迫综合征的临床研究

Clinical trial of methylprednisolone sodium succinate injection in the treatment of patients with respiratory distress syndrome

目的观察甲泼尼龙琥珀酸钠注射剂对呼吸窘迫综合征患者氧合指数(PaO_2/FiO_2)及血清生化指标的影响。方法将72例呼吸窘迫综合征患者随机分为试验组和对照组,每组36例。对照组患者给予常规治疗,试验组患者在对照组治疗的基础上,给予甲泼尼龙琥珀酸钠120 mg·d^(-1),静脉滴注,2组均连续治疗2周。观察并记录2组患者治疗前后的PaO_2/FiO_2、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分,检测2组患者的一氧化氮(NO)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,并观察2组药物不良反应发生情况。结果治疗后,试验组和对照组的PaO_2/FiO_2分别为(287.62±24.57)和(213.21±25.67)mmHg,APACHEⅡ评分分别为(11.23±1.66)和(15.59±2.21)分,差异均有统计学意义(均P<0.05)。试验组和对照组的NO分别为(58.88±32.76)和(74.28±32.94)μmol·L^(-1),IL-6分别为(167.94±25.29)和(213.11±21.50)pg·mL^(-1),TNF-α分别为(22.35±8.93)和(36.30±9.88)pg·mL^(-1),CRP分别为(6.43±3.02)和(9.25±2.94)mg·L^(-1),差异均有统计学意义(均P<0.05)。试验组出现短期血压升高2例,对照组无药物不良反应,差异无统计学意义(P>0.05)。结论对呼吸窘迫综合征患者给予甲泼尼龙琥珀酸钠治疗,可以显著地提高患者的PaO_2/FiO_2、降低APACHEⅡ评分及相关血清生化指标,提高患者的治疗效果,是安全有效的。

Objective To investigate the effect of methylprednisolone sodium succinate on oxygen indexes（ PaO_2/FiO_2） and serum biochemical indexes in patients with respiratory distress syndrome. Methods Seventy-two patients with respiratory distress syndrome were randomly divided into treatment group and control group,36 cases in each group.Control group was given routine treatment. Treatment group was given methylprednisolone sodium succinate 120 mg·d^（-1）,by intravenous drip on the basis of control group. All the patients were treated continuously for two weeks. The PaO_2/FiO_2 and acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） scores before and after treatment were observed. The levels of nitric oxide（ NO）,interleukin-6（ IL-6）,tumor necrosis factor-α（ TNF-α）,C-reactive protein（ CRP） and adverse drug reactions in two groups were observed. Results Aftertreatment,the PaO_2/FiO_2 levels in treatment group and control were（ 287. 62 ± 24. 57）,（ 213. 21 ± 25. 67） mmHg,the APACHE Ⅱ scores were 11. 23 ± 1. 66,15. 59 ± 2. 21,all with significant difference（ all P〈 0. 05）. The levels of NO were（ 58. 88 ± 32. 76） and（ 74. 28 ± 32. 94） μmol·L^（-1）,the levels of IL-6 were（ 167. 94 ± 25. 29） and（ 213. 11 ± 21. 50） pg·mL^（-1）,the levels of TNF-α were（ 22. 35 ± 8. 93） and（ 36. 30 ± 9. 88） pg·mL^（-1）,the levels of CRP were（ 6. 43 ± 3. 02） and（ 9. 25 ± 2. 94） mg·L^（-1）,all with significant differences（ all P 〈0. 05）.There were 2 cases of short-term elevated blood pressure in treatment group,and there was no adverse drug reaction in control group,without significant difference（ P〉 0. 05）. Conclusion Methylprednisolone sodium succinate in the treatment of respiratory distress syndrome can significantly improve the PaO_2/FiO_2,reduce the APACHEⅡ score and serum biochemical indicators,and can improve the clinical effect with high safety.