摘要
目的:对比不同剂量糖皮质激素对慢性阻塞性肺病急性加重期(AECOPD)合并危重症疾病相关性皮质醇不足(CIRCI)患者的临床疗效。方法:选取2015年6月至2017年12月于我院治疗的AECOPD合并CIRCI患者共70例,随机分为两组,分别给予氢化可的松200 mg/d(高剂量组)和氢化可的松100 mg/d(低剂量组),对比两组患者住院28 d生存率,休克和机械通气时间情况,比较治疗前和治疗7 d后的血液炎症相关指标的变化情况。结果:两组患者的28 d死亡率、28 d休克发生率、机械通气时间和住ICU时间对比,差异均无统计学意义(P>0.05)。不论治疗前后两组患者的CPIS评分、CAPS评分、FVC、FEV1和FEV1/FVC对比差异均无统计学意义(P>0.05),不论治疗前后两组患者的WBC、CRP、IL-6、TNF-α和PCT水平对比差异均无统计学意义(P>0.05),两组总不良反应对比差异无统计学意义(P>0.05)。结论:低剂量糖皮质激素治疗AECOPD合并CIRCI患者能显著改善患者的预后和肺功能,促进炎症消退,效果与高剂量相当,安全性更好。
Objective ： To compare the clinical efficacy of different doses of glucocortieoids in acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and eortisol-related cortisol deficiency （CIRCI） in critically ill patients. Methods ：A total of 70 patients with AECOPD combined with CIRCI who were treated in our hospital from June 2015 to December 2017 were randomly divided into two groups. Hydrocortisone 200 mg/d （high dose group） and hydrocortisone were given respectively. 100 mg/d （low-dose group）, the 28-day survival rate, shock and mechanical ventilation time were compared between the two groups of patients, and the change of blood inflammation related indicators before and after treatment was compared. Results ： There was no significant difference in 28-day mortality, 28-day shock, mechanical ventilation time and ICU stay time between the two groups （P〉0.05）. There was no significant difference in CPIS scores, CAPS scores, FVC, FEV1, and FEV1/FVC between the two groups before and after treatment （P〉0.05）. There were no significant difference in WBC, CRP, IL-6, TNF-icant difference in 28-day mortality, 28-day shock, mechanical ventilation time and ICU stay time between the two groups （P〉0.05）. There was no significant difference P〉 0.05 ）. Conclusion ： Low-dose glucocorticoids can significantly improve the prognosis and lung function in patients with AECOPD combined with CIRCI and promote the resolution of inflammation. The effect is similar to that of high dose, and the safety is better.
作者
李亦东
方笑媚
LI Yi-dong;FANG Xiao-mei(The Seventh Department of lnternal Medicine,Dongguan Chinese Medicine Hospital,Guangdong,523000;Intensive Care Unit,Dongguan Chinese Medicine Hospital,Dongguan,Guangdong)
出处
《岭南急诊医学杂志》
2018年第5期428-430,433,共4页
Lingnan Journal of Emergency Medicine
