CAJ | 학술논문

目的探讨应激剂量糖皮质激素对合并危重病相关皮质醇不足(CIRCI)的早期急性呼吸窘迫综合征(ARDS)患者的病情与预后的影响.方法通过促肾上腺皮质激素(ACTH)刺激试验筛选出合并CIRCI的早期ARDS患者.按随机数字表将入选患者随机分为治疗组(静脉滴注氢化可的松100mg、3次/d、连续7d)和对照组(静脉滴注等量生理盐水).记录患者血乳酸水平、28 d内生存时间、休克发生率、28 d病死率.结果 (1)45例早期ARDS患者进行了筛查,CIRCI的发病率为57.8％,合并CIRCI的ARDS患者休克的发生率为46.2％,明显高于未合并CIRCI的ARDS患者(5/19).(2)治疗组患者入组时动脉血乳酸水平明显低于对照组[2.7(1.2,3.9) mmol/L比4.6(2.5,6.3) mmoL/L,P＜O.05].(3)与对照组比,治疗组患者28 d内生存时间明显延长,休克发生率明显下降(5/12比10/14,P＜0.05).经乳酸水平调整后治疗组28 d病死率较对照组下降(2.6/12比5.8/14),但差异无统计学意义(P＞0.05).(4)2组患者并发症发生率差异无统计学意义(P＞0.05).结论对合并CIRCI的早期ARDS患者,应激剂量糖皮质激素治疗可降低休克的发生率并延长生存时间,同时有降低患者28 d病死率的趋势.
목적 탐토응격제량당피질격소대합병위중병상관피질순불족(CIRCI)적조기급성호흡군박종합정(ARDS)환자적병정여예후적영향.방법 통과촉신상선피질격소(ACTH)자격시험사선출합병CIRCI적조기ARDS환자.안수궤수자표장입선환자수궤분위치료조(정맥적주경화가적송100mg、3차/d、련속7d)화대조조(정맥적주등량생리염수).기록환자혈유산수평、28 d내생존시간、휴극발생솔、28 d병사솔.결과 (1)45례조기ARDS환자진행료사사,CIRCI적발병솔위57.8％,합병CIRCI적ARDS환자휴극적발생솔위46.2％,명현고우미합병CIRCI적ARDS환자(5/19).(2)치료조환자입조시동맥혈유산수평명현저우대조조[2.7(1.2,3.9) mmol/L비4.6(2.5,6.3) mmoL/L,P＜O.05].(3)여대조조비,치료조환자28 d내생존시간명현연장,휴극발생솔명현하강(5/12비10/14,P＜0.05).경유산수평조정후치료조28 d병사솔교대조조하강(2.6/12비5.8/14),단차이무통계학의의(P＞0.05).(4)2조환자병발증발생솔차이무통계학의의(P＞0.05).결론 대합병CIRCI적조기ARDS환자,응격제량당피질격소치료가강저휴극적발생솔병연장생존시간,동시유강저환자28 d병사솔적추세.
Objective To investigate the effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome (ARDS) combined with critical illness-related corticosteroid insufficiency (CIRCI).Methods All early ARDS patients combined with CIRCI were screened by an adrenal corticotrophic hormone (ACTH) test and randomly divided into treatment group (hydrocortisone 100 mg intravenous,3 times/day,consecutively for 7 days,n =12 ) and control group (equivalent normal saline,n =14 ).General clinical data,changes of arterial blood gas,hemodynamics and respiratory mechanics were observed and recorded at admission and at 7 days after treatment.Ventilator-free and shock-free days,ICU stay within 28 days after admission were recorded and 28-day mortality was used as judge prognosis index.Results CIRCI rate in 45 early ARDS patients was 57.8％ ( 26 patients),and the shock rate was markedly higher in ARDS patients with CIRCI than patients without CIRCI (46.2％ vs 5/19 ).There were no significant differences in baseline parameters,oxygenation and illness severity between the treatment and control groups,except for markedly lower lactic level in the treatment group [ 2.7 ( 1.2,3.9 ) mmol/L vs 4.6 ( 2.5,6.3 ) mmol/L,P ＜ O.05].After 7 days of treatment,PaO2/FiO2 markedly increased,while heart rate obviously decreased in the both groups.Compared with the control group,survival time of patients was significantly longer and shock rate of the patients was markedly lower in treatment group within 28 days (5/12 vs 10/14,P ＜ 0.05).The 28-day mortality,which were adjusted by baseline arterial lactic,was lower in the treatment group (2.6/12 ) than in the control group (5.8/14) while with no significant difference ( P ＞ 0.05 ).There was no significant difference in complication incidence between the two groups.Conclusion Stress dose glucocorticoid could reduce shock incidence and prolong survival time,and has a tendency of lower 28-day mortality in early ARDS patients combined with CIRCI.