摘要
目的观察甲泼尼龙对急性扁桃体炎并发脓毒症心肌损伤的疗效。方法选取2018年1月至2020年12月就诊于福建省立医院急诊内科的急性扁桃体炎并发脓毒症心肌损伤的患者78例进行随机对照试验,随机分为对照组和观察组,每组39例,两组患者均予头孢曲松钠(2.0g,静脉滴注,1次/d,共10d)抗感染和基础治疗,观察组加用甲泼尼龙(每千克体重1mg,静脉注射,1次/d,共3d)治疗。比较两组患者症状缓解时间、不良反应发生率,比较治疗前后炎症指标、肌钙蛋白I和N末端B型利尿钠肽原水平的变化以及治疗前后心功能障碍发生率的变化。结果与对照组相比,观察组患者体温降至正常、咽痛缓解和扁桃体红肿消退时间均缩短(P<0.05),而不良反应发生率差异无统计学意义(P>0.05);两组患者的白细胞计数、降钙素原、肌钙蛋白I和N末端B型利尿钠肽原水平治疗前相比较差异均无统计学意义(P>0.05),治疗后较治疗前均显著下降(P<0.05),且在观察组患者中以上指标的水平比对照组低,差异有统计学意义(P<0.05);两组患者心功能障碍发生率在治疗前差异无统计学意义(P>0.05),治疗后两组患者较治疗前均显著下降(P<0.05),且观察组患者的心功能障碍发生率较对照组低,差异有统计学意义(P<0.05)。结论充分抗感染基础上加用小剂量甲泼尼龙能改善急性扁桃体炎及其并发的脓毒症心肌损伤。
Objective To investigate effects of methylprednisolone on acute tonsillitis complicated by septic myocardial injury(SMI).Methods Seventy-eight patients diagnosed as acute tonsillitis complicated by SMI admitted to our hospital from January 2018 to December 2020 were randomly divided into control group and methylprednisolone-treated group(treatment group)(n=39).All patients were given anti-infection treatment with ceftriaxone sodium(2g,once a day)and basic treatment.Besides,patients in the treatment group were given methylprednisolone(1mg/kg,once a day)intravenously for 3 days,while patients in the control group received equal volume of normal saline intravenously.The time to remission and adverse effect rate were compared between two groups.The levels of cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP)and blood inflammatory markers were detected in control group and treatment group on the day of diagnosis and the fourth day of treatment respectively;cardiac function in both groups was also evaluated by echocardiography before and after methylprednisolone treatment.Results The time to remission was reduced in treatment group in comparison to control group(P<0.05),while there was no significant difference of adverse effect rate between two groups(P>0.05).The levels of cTnI,NT-proBNP,blood inflammatory markers and the rate of cardiac dysfunction were significantly reduced in both groups on the fourth day of treatment(P<0.05).Moreover,compared with control group,patients in treatment group had lower levels of cTnI,NT-proBNP and blood inflammatory markers and lower rate of cardiac dysfunction after methylprednisolone treatment(P<0.05).Conclusion Low dose of methylprednisolone combined with anti-infective treatment could ameliorate acute tonsillitis complicated by SMI.
作者
郑武洪
肖鹏
周海珺
柯俊
Zheng Wuhong;Xiao Peng;Zhou Haijun;Ke Jun(Department of Emergency Internanl Medicine,Fujian Provincial Hospital,Fuzhou 350001,China;Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Fujian Provincial Institute of Emergency Medicine,Fuzhou 350001,China;Fujian Emergency Medical Center,Fuzhou 350001,China;Fujian Provincial Key Laboratory of Emergency Medicine,Fuzhou 350001,China)
出处
《创伤与急诊电子杂志》
2021年第2期75-79,84,共6页
Journal of Trauma and Emergency(Electronic Version)
基金
福建医科大学启航基金项目(2018QH1123)。
