小剂量糖皮质激素对脓毒症休克患者免疫的影响

Analysis of the efficacy of low dose glucocorticoid on immunity in patients with septic shock

目的探究小剂量糖皮质激素对脓毒症休克患者免疫的影响。方法选取2017年8月-2019年4月上海市浦东新区人民医院收治的96例脓毒症休克患者为研究对象,随机分为观察组以及对照组,每组各48例。对照组接受常规治疗,观察组在对照组基础上接受激素治疗。比较两组患者的血流动力学指标、氧合指标、单核细胞人类白细胞抗原(HLA)-DR以及序贯器官衰竭估计评分(SOFA)评分结果。结果治疗后12、24 h,观察组患者平均动脉压(MAP)水平高于对照组(P<0.05),治疗后24、48 h观察组心率(HR)水平低于对照组(P<0.05)。治疗后12、24 h及48 h观察组患者的血乳酸水平低于对照组(P<0.05),氧合指数(PaO2/FIO2)水平高于对照组(P<0.05)。治疗后1周,两组患者单核细胞HLA-DR水平上升,SOFA评分均降低,且观察组患者的单核细胞HLA-DR水平高于对照组(P<0.05),SOFA评分低于对照组(P<0.05)。结论常规治疗基础上应用小剂量糖皮质激素治疗脓毒症休克效果较好,可有效改善患者血流动力学及氧合功能,调节机体免疫,保护脏器功能,值得临床推广应用。

Objective To investigate the effects of low dose glucocorticoid on the immunity in the patients with septic shock.Methods 96 patients with septic shock were randomLy divided into 2 equal groups:control group receiving routine treatment,and observation group receiving injection of hydrocortisone sodium succinate per 6 hours for 7 days,hormone therapy on the basis of the control group.The levels of hemodynamic indexes,oxygenation indexes,Monocyte human leukocyte antigen(HLA)-DR and score of sequential organ failure assessment(SOFA)were compared between the two groups.Results 12 h and 24 h after treatment,the level of mean arterial pressure(MAP)in the observation group was higher than that in the control group(P<0.05).24 hours after treatment,the heart rate(HR)level in the observation group was lower than that in the control group(P<0.05).At 12 h,24 h and 48 h after treatment,the blood lactic acid level in the observation group was lower than that in the control group(P<0.05),and the level of Pa02/FI02 was higher than that in the control group(P<0.05).One week after treatment,the level of monocyte HLA-DR increased in both groups and the level of HLA-DR in monocytes in the observation group was higher than that in the control group(P<0.05).The score of SOFA decreased in both groups,and the score of SOFA in the observation group was lower than that in the control group(P<0.05).Conclusion On the basis of routine treatment,the application of low dose glucocorticoid in the treatment of septic shock is effective.It can effectively improve the hemodynamics and oxygenation function of patients,regulate the immunity of the body and protect the organ function,which is worthy for clinical application.