低剂量长疗程糖皮质激素治疗急性呼吸窘迫综合征的效果及安全性研究

摘要

Objective To explore the ef fi cacy and safety of long-term use of low dose glucocorticoids in acute respiratory distress syndrome (ARDS). Methods Fifty ARDS patients were randomly divided into two groups. The control group(25 patients)received non-invasive or invasive mechanical ventilation,antibiotics and support treatments. The glucocorticoids group(25 patients)received the same treatments plus long-term use of low dose glucocorticoids. Results The mortality in glucocorticoids group(32％(8/25))was much lower than that in the control group(60％(15/25))(P < 0.05). The ventilator-free days and organ failure-free days within 28d in glucocorticoids group were significantly higher than those in the control group (P < 0.05). The oxygenation index and the serum IL-8 levels in glucocorticoids group at 14d and 28d were higher than those in the control group(P<0.05). Compared to the control group ,long-term use of low dose glucocorticoids in ARDS did not increase fasting blood-glucose at 7d,gastrointestinal bleeding and hospital infections within 28d. Conclusions Long-term use of low dose glucocorticoids in ARDS could reduce the serum IL-8 levels and improve the prognosis.%目的 探讨低剂量长疗程糖皮质激素治疗急性呼吸窘迫综合征(ARDS)的效果及安全性.方法 2014年1月至2017年4月在呼吸科进行治疗的ARDS患者,随机分为两组,对照组25例患者采取无创或有创机械通气、抗生素、对症及支持治疗,糖皮质激素组25例患者在常规治疗的同时加用低剂量长疗程糖皮质激素.结果 糖皮质激素组60 d内病死率(32％)低于对照组(60％)(P<0.05).糖皮质激素组28 d内无机械通气时间、28 d内无心、肝、肾功能衰竭时间均显著高于对照组(P<0.05).糖皮质激素组第14、28天氧合指数显著高于对照组而血清IL-8水平显著低于对照组(P<0.05).两组患者第7天空腹血糖、28 d内消化道出血人次、28 d内院感人次无显著差异(P>0.05).结论 低剂量长疗程糖皮质激素能显著降低ARDS患者血清IL-8水平并改善预后.