摘要
目的探讨糖皮质激素(GC)在重症急性胰腺炎(SAP)诱发急性呼吸窘迫综合征(ARDS)综合救治中的价值。方法收集25例SAP致ARDS患者的临床资料进行统计与分析,GC应用均在ARDS发生前后1-3d,剂量(220.2±139.6)mg/d,相当于甲基氢化泼尼松80-500mg,/d,病情改善后减量,疗程为1-22d,平均(5.9±6.2)d。结果25例患者,GC组16例(64.0%),接受机械通气治疗15例(93.8%);非GC组9例,接受机械通气治疗8例。GC组器官功能和代谢并发症评分、多脏器功能不全发生数量、手术与持续肾脏替代治疗患者均明显多于非GC组(P<0.05),两组病死率相仿(P>0.05)。GC组治疗后72h,PaO2/FiO2与Qs/Qt改善明显(P<O.05),7例顽固性休克,有4例(57.1%)缓解。结论GC能改善SAP致ARDS患者顽固性缺氧和休克,常规机械通气和药物治疗不佳时可考虑应用。
Objective To evaluate the effect of glucocorticoid(GC)in the treatment for patients with acute respiratory distress syndrome (ARDS) resulting from severe acute pancreatitis (SAP). Methods The clinical data from 25 patients with ARDS resulting from SAP were collected and analyzed. In GC group, GC was given before or after the onset of ARDS 1 to 3 d and the dosage was comparable with methylprednisolone 80 - 500(220.2±139. 6)mg/d. It would be decreased when hypoxemia and shock improved. The therapeutic course lasted 1 to 22 d [average(5. 9±6.2) d]. Results Among 25 cases, 23 (92.0%) received ventilation and 16(64. 0% ) took GC. Organic functional or diabetic complications, and multiple organic dysfunction failure, operation and continual replacement renal therapy in GC group were more than non-GC ( P < 0. 05 ) . Their mortality rate was the same( P > 0. 05 ) . Their PaO2/ FiO2 and Qs/Qt were improved significantly by GC after 72 h ( P < 0. 05). Among 7 cases with refractory shock, 4 (57.1%) were resolved. Conclusion GC would improve refractory hypoxemia and shock in ARDS resulting from SAP. When there were no benefits from ordinary mechanical ventilation and drug therapy, GC should be given without hesitation.
出处
《上海第二医科大学学报》
CSCD
北大核心
2005年第1期53-56,共4页
Acta Universitatis Medicinalis Secondae Shanghai
基金
上海市卫生局科技发展基金(00409)资助项目.
