小剂量氢化可的松治疗严重脓毒症患者的疗效观察

摘要

Objective To research the effect of low⁃dose hydrocortisone treatment on prognosis and inflammation of severe sepsis patient. Methods Severe sepsis patient who met the inclusion criteria were randomly divided into treatment group and control group. The two groups were evaluated with APACHEⅡand given routine therapy. The treatment group was treated with additional low⁃dose hydrocortisone. To compare mortality, time of using of vasoactive agent, emergency intensive care unit length of stay, hospital length of stay and the concentration of interleukin⁃6 at 0,1,3,5 days between the two groups. Results 56 patients were enrolled in treatment group and 50 in control group. There was no significant difference of age, gender and mean APACHE Ⅱ scores in the two groups. After treatment, there was no significant difference of mortality, time of using of vasoactive agent, emergency intensive care u⁃nit length of stay, hospital length of stay and the concentration of interleukin⁃6 at 0,1,3,5 days in the two groups. Concentration of interleukin⁃6 of treatment group was decreased compared to the control group. Conclusion Low⁃dose hydrocortisone treatment can re⁃duce inflammatory response in patients with severe sepsis. No definitive improvement in outcomes can be attributable to adjunctive low⁃dose hydrocortisone therapy.%目的：观察小剂量氢化可的松对严重脓毒症患者预后和炎症反应的影响。方法按照是否进行小剂量氢化可的松治疗将符合入选标准的患者随机分为治疗组和对照组，对两组患者进行急性生理与慢性健康（ APACHE Ⅱ）评分，治疗组在常规治疗基础上加用小剂量氢化可的松治疗。比较两组患者死亡率、血管活性药物使用天数、住EICU和总住院时间及0、1、3、5 d血清白介素⁃6（ interleukin，IL⁃6）浓度。结果共入选治疗组56例，对照组50例。两组患者入院时的年龄、性别和APACHE Ⅱ评分差异无统计学意义，治疗后两组患者的死亡率、血管活性药物使用天数、住急诊监护病房（ EICU）时间和总住院时间差异无统计学意义（ P＞0．05）。治疗组患者的IL⁃6水平明显低于对照组。结论小剂量氢化可的松治疗能减轻严重脓毒症患者的炎症反应，但不能明显改善严重脓毒症患者的预后。