小剂量氢化可的松联合去甲肾上腺素治疗脓毒性休克的效果

Efficacy of low-dose hydrocortisone combined with norepinephrine on septic shock

目的:分析去甲肾上腺素联合小剂量氢化可的松治疗脓毒性休克的临床疗效。方法:选取2017年2月至2020年2月在南通大学附属医院接受治疗的脓毒性休克患者98例作为研究对象,随机分为对照组与联合治疗组。对照组单纯采取去甲肾上腺素治疗,联合治疗组在其基础上联合小剂量氢化可的松治疗。比较两组患者在休克改善时间、28 d生存率、住院病死率、ICU停留时间和总住院时间之间的差异及治疗前后炎症因子表达变化。结果:联合治疗组在休克改善时间、ICU停留时间和总住院时间均明显短于对照组,28 d生存率高于对照组,住院病死率低于对照组(P<0.05)。另外,两组患者治疗前炎症因子表达指标差异无统计学意义(P>0.05),经治疗后联合治疗组免疫指标、炎症因子水平均较对照组显著下降(P<0.05)。结论:去甲肾上腺素联合小剂量氢化可的松治疗能显著减少脓毒性休克患者外周血炎症因子表达,缩短休克改善时间、ICU停留时间和总住院时间,并提高28 d生存率,值得推广。

Objective:To investigate the efficacy of low-dose hydrocortisone combined with norepinephrine on septic shock.Methods:From February 2017 to February 2020,a total of 98 septic shock patients who were admitted to the Affiliated Hospital of Nantong University were involved in the study.All of them were randomly divided into a control group and a combined treatment group.The control group received norepinephrine;the combined treatment group received low-dose hydrocortisone plus norepinephrine.Shock reversal time,28-day survival rate,in-hospital mortality,ICU stay time and total length of hospital stay were evaluated,and the expressions of inflammatory cytokines were detected.Results:Shock reversal time,ICU stay time and hospital length of stay of the combined treatment group were significantly shorter than those of the control group.The 28-day survival rate was significantly higher and in-hospital mortality rate significantly lower than those of the control group(P<0.05).In addition,expressions of inflammatory cytokines between the two group have no statistically significant difference(P>0.05).After treatment,immunity index and inflammatory cytokines of the combined treatment group were significantly decreased compared with the control group(P<0.05).Conclusion:Low-dose hydrocortisone combined with norepinephrine could significantly reduce expressions of inflammatory cytokines,shorten shock reversal time,ICU stay time and hospital length of stay,and improve 28-day survival rate of septic shock patients significantly ameliorate the outcome of,which is worth promotion.