CAJ | 학술논문

目的：临床观察小剂量甲基泼尼龙注射液对感染性休克患者血管外肺水（EVLWI）的影响，以评价甲泼尼松龙注射液对感染性休克的治疗作用。方法根据感染性休克的诊断标准选取48例感染性休克患者，随机分成甲泼尼龙治疗组（治疗组）（n=28）和对照组（n=20），均接PICCO监护仪测得治疗前、治疗后第1、3、5天EVLWI，并同步监测氧合指数（PaO2/FIO2）和降钙素原（PCT）及免疫指标HLA-DR，对两组所得数据进行统计学分析。结果（1）EVLWI：甲泼尼龙治疗组在治疗后3、5d，EVLWI有明显下降；对照组在3d时EVLWI升高，5d开始下降，（P<0.05）。（2）氧合指数：甲泼尼龙治疗组第3天时氧合指数正常，较治疗前有明显升高（P<0.01），对照组氧合指数在5d升至正常，两组比较差异有统计学意义（P<0.05）。（3）HLA-DR：两组差异无统计学意义（P>0.05）。（4）PCT：甲泼尼龙治疗组与对照组均有不同程度下降，两组差异无统计学意义（P>0.05）。（5）病死率、机械通气时间：甲强龙治疗组与对照组病死率均有下降，两组差异无统计学意义（P>0.05），甲强龙治疗组机械通气时间较对照组明显缩短（P<0.05）。结论甲泼尼龙注射液通过抑制全身炎性反应，能降低感染性休克患者的血管外肺水指数，改善患者的氧合，减少机械通气时间。同时HLA-DR未下降，提示甲泼尼龙能改善感染性休克患者的血管外肺水，从而提高抢救成功率，对患者免疫功能影响较小。
목적：림상관찰소제량갑기발니룡주사액대감염성휴극환자혈관외폐수（EVLWI）적영향，이평개갑발니송룡주사액대감염성휴극적치료작용。방법근거감염성휴극적진단표준선취48례감염성휴극환자，수궤분성갑발니룡치료조（치료조）（n=28）화대조조（n=20），균접PICCO감호의측득치료전、치료후제1、3、5천EVLWI，병동보감측양합지수（PaO2/FIO2）화강개소원（PCT）급면역지표HLA-DR，대량조소득수거진행통계학분석。결과（1）EVLWI：갑발니룡치료조재치료후3、5d，EVLWI유명현하강；대조조재3d시EVLWI승고，5d개시하강，（P<0.05）。（2）양합지수：갑발니룡치료조제3천시양합지수정상，교치료전유명현승고（P<0.01），대조조양합지수재5d승지정상，량조비교차이유통계학의의（P<0.05）。（3）HLA-DR：량조차이무통계학의의（P>0.05）。（4）PCT：갑발니룡치료조여대조조균유불동정도하강，량조차이무통계학의의（P>0.05）。（5）병사솔、궤계통기시간：갑강룡치료조여대조조병사솔균유하강，량조차이무통계학의의（P>0.05），갑강룡치료조궤계통기시간교대조조명현축단（P<0.05）。결론갑발니룡주사액통과억제전신염성반응，능강저감염성휴극환자적혈관외폐수지수，개선환자적양합，감소궤계통기시간。동시HLA-DR미하강，제시갑발니룡능개선감염성휴극환자적혈관외폐수，종이제고창구성공솔，대환자면역공능영향교소。
Objective To observe the effect of small dose methyl prednisolone injection on extravascular lung water(EVLWI)in patients with septic shock o evaluate the influence,methylprednisolone injection on the treatment of septic shock effect. Methods According to the diagnostic criteria of septic shock, 48 cases of septic shock patients were selectedand randomly divided into methylprednisolone treatment group(n=28)and control group(n=20),the EVLWI were measured by the PICCO monitor before the treatment and the 1st,3rd,5th days after it,and oxygenation index(PaO2/FIO2)and drop procalcitonin(PCT)and immune indexes of HLA-DR were simultaneously monitored and the data were statistically analyzed two groups of income. Results (1)EVLWI:methylprednisolone treatment group after treatment on the 3rd d and the 5th d,EVLWI decreased significantly;EVLWI in the control group increased in the 3rd d while began to decline on the5th d (P<0.05).(2)oxygenation index:oxygenation index in methylprednisolone treatment group were normal and increased significantly compared with those before treatment(P<0.01)on the 3rd d ,the control group oxygenation index on the 5th d went to normal,there was significant difference between two groups(P<0.05).(3)HLA-DR:there was no significant difference between two groups(P>0.05);(4)PCT:methylprednisolone treatment group and control group had varying degrees of decline, with no significant difference between two groups(P>0.05);(5)mortality,duration of mechanical ventilation:mortality rate was decreased both in methylprednisolone treatment group and the control groupwith no significant difference between two groups(P>0.05), duration of mechanical ventilation was significantly shorter in methylprednisolone treatment group than the control group(P<0.05). Conclusion Methylprednisolone injection on systemic inflammatory responsecan reduce the infection index of extravascular lung water in septic patients,improve the patient's oxygenation,decrease the duration of mechanical ventilation. At the same time,HLA-DR is not decreased,suggesting that methylprednisolone can improve the patients with septic shock in extravascular lung water,so as to improve the success rate of rescue with little effect on the immune function of patients.