糖皮质激素治疗急性呼吸窘迫综合征58例临床分析

Clinical analysis of glucocorticoid treatment in 58 cases with acute respiratory distress syndrome

目的 评价糖皮质激素在急性呼吸窘迫综合征(ARDS)救治中的作用。方法 回顾性分析我院1992年8月～2001年5月58例临床确诊为ARDS患者的临床资料,其中肺内型ARDS组(ARDSp)18例,肺外型ARDS组(ARDSexp)40例。各组再以使用地塞米松情况分为:≥30 mg/d组、<30 mg/d组和非激素治疗组。结果 各组病情程度相当,组间APACHEⅡ评分比较差异无显著性(p>0.05)。激素用量≥30 mg/d组与<30 mg/d组及非激素治疗组比较,病情改善天数及使用呼吸机治疗天数均明显缩短,差异有显著性(P<0.01)。58例患者总病死率为20.7％,ARDSp组、ARDSexp组中激素用量≥30 mg/d组的病死率分别为14.3％、11.5％,均低于ARDSp与ARDSexp组的平均病死率(分别为22.2％、20.0％)。所有病例未见感染扩散或加重。结论 早期、足量、适当疗程应用糖皮质激素治疗ARDS可及时逆转过度失控的炎症反应,缓解病情,降低病死率。

Objective To evaluate the effect of glucocorticoid on treatment in patients with acute respiratory distress syndrome (ARDS) . Methods Data of 58 cases with ARDS during August 1992 to May 2001 were analyzed retrospectively, which were divided into two groups, 18 cases with pulmonary ARDS (ARDSp) and 40 cases with extrapulmonary ARDS (ARDSexp), and each group was re-divided into ≥30 mg/d and < 30 mg/d of dexamethasone, and non-steroid group, respectively. Results General condition was similar in the two groups. There was no significant difference in the scores of APACHE II among these groups ( P>0.05) . The time for improvement of patient's general condition and the days with mechanical ventilation support shortened in the group with ≥30 mg/d of dexamethasone, as compared with those with<30 mg/d of it and non-steroid ( P < 0.01) . The overall mortality rate was 20.7 % in 58 cases. In ARDSp and the ARDSexp groups, the mortality rate in ≥30 mg /d of dexamethasone group were 14.2% and 11.5% , respectively, which were lower than the averages of those (22.2% and 20.0%), respectively. Neither aggravation, nor spread of infection was found. Conclusions The study suggested that early therapy with high dose glucocorticoid for a proper course could improve clinical symptom, reverse uncontrolled inflammatory reaction, alleviate patient's condition and decrease the morthality of ARDS. Glucocorticoid played an important role in rescuing and treating the patients with ARDSp and ARDSexp.