糖皮质激素联合目标液体复苏法对脓毒症休克患儿组织灌注指标、免疫功能及乳酸清除率的影响

Effects of glucocorticoids combined with target fluid resuscitation on tissue perfusion index, immune function and lactate clearance rate in children with septic shock

目的 :探讨糖皮质激素联合目标液体复苏对脓毒症休克患儿组织灌注、免疫功能及乳酸清除率的影响。方法 :选取符合纳入条件的80例脓毒症休克患儿,随机均分为对照组与观察组每组40例,对照组采用目标液体复苏治疗,观察组在对照组基础上加用糖皮质激素治疗,比较两组患儿治疗前后临床症状改善情况,测定乳酸清除率、组织灌注指标及免疫功能的改善情况。结果 :(1)治疗后,两组MAP、CVP、尿量、Scv O2上升,与治疗前对比差异有统计学意义,观察组各指标上升幅度高于对照组;(2)治疗6h、1d、3d、1周,两组血乳酸水平均降低,乳酸清除率上升,与治疗前对比差异有统计学意义,观察组治疗后不同时间点乳酸降低幅度高于对照组,乳酸清除率高于对照组;(3)治疗后,两组APACHEⅡ评分、SOFA评分均降低,观察组不同时间点评分降低幅度均高于对照组;(4)观察组治疗后CD3+、CD4+、CD8+均高于对照组。结论 :采用糖皮质激素联合目标液体复苏治疗脓毒症休克患儿,可降低患儿血乳酸水平,提高乳酸清除率,改善其组织灌注状况,提高机体免疫功能。

Objective To investigate the effects of glucocorticoids combined with target fluid resuscitation on tissue per-fusion index, immune function and lactate clearance rate in children with septic shock. Methods Eighty children with septic shock who met the inclusion criteria were randomized into the control group and the observation group with 40 cases in each group. The control group was treated with target fluid resuscitation while the observation group was treated with glucocorti-coids, on the basis of the control group. The relief of clinical symptoms before and after treatment was compared between the two groups. The lactate clearance rate, tissue perfusion index and improvement of immune function were measured. Results ①After treatment, MAP, CVP, urine volume and ScvO2 of both groups increased. Compared with those before treatment, there were significant differences, and the increasing range in observation group was significantly greater than that in control group; ②After 6h, 1d, 3d and 1 week of treatment, the blood lactate levels were reduced while lactic acid clearance rate increased. Compared with those before treatment, there were significant differences. The decreasing ranges of lactate in observation group at different time points after operation were greater than those in control group, and the lactic acid clearance rates were higher than those in control group; ③After treatment, the APACHE II scores and SOFA scores of both groups were decreased, and the decreasing range in observation group at different time points were lower than those in the control group; ④After treatment, CD3+, CD4+and CD8+ in the observation group were higher than those in the control group. Conclusion The application of glucocorticoids combined with target fluid resuscitation in the treatment of septic shock in children can reduce the blood lactate levels, increase lactate clearance rate, improve the status of tissue perfusion, and improve the immune function.