目的：探讨小剂量糖皮质激素辅助治疗严重脓毒症急性肾损伤(AKI)的效果。方法将55例严重脓毒症 AKIⅠ期患者随机分为激素组29例和对照组26例,两组均予以脓毒症常规治疗,激素组在此基础上加用小剂量氢化可的松琥珀酸钠(200 mg/ d)。统计两组治疗7 d 的血肌酐、胱抑素 C、肾小球滤过率、降钙素原、尿量等指标,并进行 APACHEⅡ评分,比较两组患者7、14 d 的治疗效果。同时根据使用抗生素后激素的使用时间定义为：早期组(激素使用时间<9 h)16例,晚期组(激素使用时间≥9 h)13例,统计两个亚组患者的治疗情况。结果治疗7 d 时激素组患者肾功能恢复情况优于对照组(P <0.05),14 d 时激素组患者肾功能恢复情况较对照组好,但是差异无统计学意义(P >0.05)。严重脓毒症患者肾上腺皮质功能不全组的肾功能恢复情况优于肾上腺皮质功能正常组(P <0.05)。早期即9 h 之内使用糖皮质激素患者的肾功能恢复程度优于晚期组,APACHEⅡ评分及降钙素原浓度低于晚期使用组(P <0.05)。结论早期使用小剂量糖皮质激素可改善严重脓毒症急性肾损伤,尤其是合并肾上腺功能不全的患者。%Objective To study the effect of low dose of glucocorticoid in severe sepsis patients with acute kidney injury. Methods 55 cases of severe sepsis patients combined acute kidney injury were selected and randomly divided into glucocorticoids(GC) group( n = 29) and control group( n =26). Both of the two groups were given the therapy of severe sepsis and low dose of GC was added. We observed and evaluated the SCr, CysC, GFR, PCT, daily urine output and the APACHEⅡ score as well as the effect of 7 days and 14 days. In addition we defined the GC group as early group of 16 cases ( <9 hours late, the use of GC) and group of 13 cases (GC use longer than 9 hours)accord to the use of GC after the use of antibiotics. Results Onday 7, the SCr, CysC, PCT and APACHEⅡscores of patients in glucocorticoids group were significantly lower than the control group. The GFR and the urineoutputin the GC group was significantly higher than the control group. Then we analysedadrenal function and found that the renal function in patients with adrenal insufficiency was superior to those of the normal adrenal function group. Conclusion Low dose GC can improve severe sepsis patients with acute kidney injury especially who suffer the adrenal insufficiency.
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