摘要
目的：临床观察小剂量甲基泼尼龙注射液对感染性休克患者血管外肺水（EVLWI）的影响，以评价甲泼尼松龙注射液对感染性休克的治疗作用。方法根据感染性休克的诊断标准选取48例感染性休克患者，随机分成甲泼尼龙治疗组（治疗组）（n=28）和对照组（n=20），均接PICCO监护仪测得治疗前、治疗后第1、3、5天EVLWI，并同步监测氧合指数（PaO2/FIO2）和降钙素原（PCT）及免疫指标HLA-DR，对两组所得数据进行统计学分析。结果（1）EVLWI：甲泼尼龙治疗组在治疗后3、5d，EVLWI有明显下降；对照组在3d时EVLWI升高，5d开始下降，（P〈0.05）。（2）氧合指数：甲泼尼龙治疗组第3天时氧合指数正常，较治疗前有明显升高（P〈0.01），对照组氧合指数在5d升至正常，两组比较差异有统计学意义（P〈0.05）。（3）HLA-DR：两组差异无统计学意义（P〉0.05）。（4）PCT：甲泼尼龙治疗组与对照组均有不同程度下降，两组差异无统计学意义（P〉0.05）。（5）病死率、机械通气时间：甲强龙治疗组与对照组病死率均有下降，两组差异无统计学意义（P〉0.05），甲强龙治疗组机械通气时间较对照组明显缩短（P〈0.05）。结论甲泼尼龙注射液通过抑制全身炎性反应，能降低感染性休克患者的血管外肺水指数，改善患者的氧合，减少机械通气时间。同时HLA-DR未下降，提示甲泼尼龙能改善感染性休克患者的血管外肺水，从而提高抢救成功率，对患者免疫功能影响较小。
Objective To observe the effect of small dose methyl prednisolone injection on extravascular lung water（EVLWI）in patients with septic shock o evaluate the influence,methylprednisolone injection on the treatment of septic shock effect. Methods According to the diagnostic criteria of septic shock, 48 cases of septic shock patients were selectedand randomly divided into methylprednisolone treatment group（n=28）and control group（n=20）,the EVLWI were measured by the PICCO monitor before the treatment and the 1st,3rd,5th days after it,and oxygenation index（PaO2/FIO2）and drop procalcitonin（PCT）and immune indexes of HLA-DR were simultaneously monitored and the data were statistically analyzed two groups of income. Results （1）EVLWI：methylprednisolone treatment group after treatment on the 3rd d and the 5th d,EVLWI decreased significantly;EVLWI in the control group increased in the 3rd d while began to decline on the5th d （P〈0.05）.（2）oxygenation index：oxygenation index in methylprednisolone treatment group were normal and increased significantly compared with those before treatment（P〈0.01）on the 3rd d ,the control group oxygenation index on the 5th d went to normal,there was significant difference between two groups（P〈0.05）.（3）HLA-DR：there was no significant difference between two groups（P〉0.05）;（4）PCT：methylprednisolone treatment group and control group had varying degrees of decline, with no significant difference between two groups（P〉0.05）;（5）mortality,duration of mechanical ventilation：mortality rate was decreased both in methylprednisolone treatment group and the control groupwith no significant difference between two groups（P〉0.05）, duration of mechanical ventilation was significantly shorter in methylprednisolone treatment group than the control group（P〈0.05）. Conclusion Methylprednisolone injection on systemic inflammatory responsecan reduce the infection index of extravascular lung water in septic patients,improve the patien
出处
《浙江临床医学》
2014年第7期1044-1046,共3页
Zhejiang Clinical Medical Journal
基金
浙江省丽水市科技局课题（2012JYZB81）
