氢化可的松持续静脉微量泵入联合注射胸腺肽α1对脓毒症休克患者血糖波动和炎性因子的影响

Effect of continuous intravenous microinjection of hydrocortisone combined with thymosin α1 on blood glucose fluctuation and inflammatory factors in septic shock patients

目的探讨氢化可的松持续静脉微量泵入联合注射胸腺肽α1对脓毒症休克的治疗效果。方法选择2015年1月—2018年10月陆军军医大学第二附属医院急诊科收治脓毒症休克患者120例,按随机数字表法将患者分为3组,缓慢静滴组(n=38)给予氢化可的松缓慢静脉滴注治疗,微量泵入组(n=42)给予持续静脉微量泵入治疗,联合治疗组(n=40)给予氢化可的松持续静脉微量泵入联合胸腺肽α1治疗,疗程7 d。观察3组治疗效果、血糖波动,比较3组治疗期间血清炎性因子水平和不良反应。结果联合治疗组总有效率为62.50%,显著高于微量泵入组的35.71%和缓慢静滴组的34.21%(χ^2=8.196,P=0.017)。联合治疗组休克持续时间、总住院时间明显短于微量泵入组和缓慢静滴组(F=11.874、7.462,P=0.000、0.001);联合治疗组28 d病死率为35.00%,显著低于微量泵入组的59.52%和缓慢静滴组的71.05%(χ^2=10.768,P=0.005)。联合治疗组、微量泵入组平均血糖水平(MBG)、最大血糖波动幅度(LAGE)、高血糖时间窗均显著低于缓慢静滴组(F=10.475、11.339、15.597,P均=0.000)。与治疗前相比,治疗后1 d、7 d、14 d 3组血清降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和超敏-C反应蛋白(hs-CRP)均呈先升高后逐渐降低趋势;联合治疗组治疗后7 d、14 d血清PCT、IL-6、TNF-α和hs-CRP显著低于微量泵入组和缓慢静滴组(P<0.05),微量泵入组和缓慢静滴组治疗后血清PCT、IL-6、TNF-α和hs-CRP比较差异无统计学意义(P>0.05)。结论氢化可的松持续静脉微量泵入联合注射胸腺肽α1可以有效降低脓毒症休克患者机体炎性因子,患者血糖波动更低,安全性较高。

Objective To investigate the therapeutic effect of hydrocortisone combined with thymosinα1 on septic shock.Methods From January 2015 to October 2018,120 patients with septic shock were admitted to the emergency department of the Second Affiliated Hospital of Army Medical University.The patients were divided into three groups according to the random number table.The group of slow intravenous drip(n=38)was given hydrocortisone slow intravenous drip.In the micro pump group(n=42),continuous intravenous micro pump therapy was given.In the combined treatment group(n=40),hydrocortisone was continuously pumped into the vein in combination with thymosinα1 for 7 days.The therapeutic effect and blood glucose fluctuation of the three groups were observed,and the levels of serum inflammatory factors and adverse reactions were compared.Results The total effective rate was 62.50%in the combination treatment group,which was significantly higher than 35.71%in the micro pumping group and 34.21%in the slow intravenous group(χ2=8.196,P=0.017).The duration of shock and total hospital stay in the combination treatment group were significantly shorter than those in the micro pumping group and the slow intravenous group(F=11.874,7.462,P=0.000,0.001).The 28-day mortality rate was 35.00%in the combination group,which was significantly lower than 59.52%in the micro pumping group and 71.05%in the slow intravenous group(χ2=10.768,P=0.005).The average blood glucose level(MBG),maximum blood glucose fluctuation(LAGE),and hyperglycemia time window in the combined treatment group and micro pump group were significantly lower than those in the slow intravenous group(F=10.475,11.339,15.597;P=0.000).Serum procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α)and hypersensitive C-reactive protein at 1 d,7 d,and 14 d after treatment compared with pre-treatment(hs-CRP)increased first and then gradually decreased.Serum PCT,IL-6,TNF-αand hs-CRP were significantly lower in the combination treatment group than in the micro pumping group and the slow intravenous infusion group at 7 and 14 days after treatment(P<0.05).There was no significant difference in serum PCT,IL-6,TNF-αand hs-CRP between the micro pump and the slow intravenous group(P>0.05).Conclusion Hydrocortisone continuous intravenous micro pump combined with thymosinα1 injection can effectively reduce inflammatory factors in septic shock patients,lower blood sugar fluctuation and higher safety.