儿童脓毒症糖皮质激素和静脉免疫球蛋白应用的时机和剂量

The timing and dose of glucocorticoids and intravenous immunoglobulins in children with sepsis

脓毒症是导致儿童死亡的重要原因之一，其病理生理的中心环节是感染引起宿主炎症免疫失衡。糖皮质激素（Gc）和静脉免疫球蛋白（IVIG）通过免疫调控参与脓毒症治疗。但GC和IVIG治疗脓毒症的具体时机、剂量和疗程的存在较多争议。当前，小剂量Gc（氢化可的松5mg／kg·d）推荐应用于儿茶酚胺抵抗的难治性脓毒性休克，Gc使用至血流动力学稳定即可停药。严重脓毒症患者，早期短疗程使用小剂量IVIG（200—400mg／kg·d×2—3d）有助于提高机体病原清除能力并降低病死率。

Sepsis remains an important cause of death in children worldwide. The immunologic disso- nance caused by infection is the central link of pathophysiology of sepsis. Both glucocorticoid and intravenous immunoglobulins participated in immune regulation and the treatment of sepsis, however, the timing, dosage and course of treatment with glucoeorticoid and intravenous immunoglobulins remain controversial. Relativity adrenocortical insufficiency occurs during sepsis, a small dose of hydrocortisone （5mg/kg） is recommended for refractory septic shock due to catecholamine resistance. The serum immunoglobulins level was decreased in the early stage of sepsis, and the short-term low-dose IVIG （200-400mg/kg ~ d, 2-3d） may helpful to remove the inflammatory mediators and improve the outcome.