临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2014年
6期
685-688
,共4页
呼吸窘迫综合征,成人%糖皮质激素类%预后
呼吸窘迫綜閤徵,成人%糖皮質激素類%預後
호흡군박종합정,성인%당피질격소류%예후
respiratory distress syndrome,adult%glucocorticoids%prognosis
目的:评价糖皮质激素(glucocorticoids,GCs)在重症监护室(intensive care unit,ICU)治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)中的作用。方法回顾性分析本院入住 ICU的 ARDS患者的临床资料,并根据致病因素在肺损伤中的作用,将所入选患者分为肺内源性 ARDS(primarily from pulmonary diseases, ARDSp)和肺外源性 ARDS(primarily from extra-pulmonary diseases,ARDSexp);ARDSp患者62例,ARDSexp患者101例。根据 GCs的使用量各分为3组,分析 ARDSp及 ARDSexp应用 GCs 和未应用 GCs 患者的病情改善和病死率。结果 ARDSp及 ARDSexp患者各组急性生理与慢性健康评分(Acute Physiology and Chronic Health EvaluationⅡ,APACHE-Ⅱ)相当(P>0.05)。GCs治疗<30 mg/d组与≥30 mg/d组比较,病情改善时间和呼吸机治疗时间明显缩短(P<0.01),病死率也略低(P>0.05);GCs治疗<30 mg/d组与非 GCs治疗组比较差异有统计学意义(P<0.01);≥30 mg/d组与非 GCs治疗组比较差异无统计学意义(P>0.05)。ARDS患者总体病死率23.3%(38/163),其中使用 GCs治疗组病死率22.8%(34/149),未使用 GCs治疗组病死率28.6%(4/14)(P >0.05)。结论低剂量(<30 mg/d)、早期应用(24 h内)、长期疗程(>7 d)的GCs,可及时遏制炎性介质的“瀑布样效应”,在一定程度上缩短病程,降低病死率。
目的:評價糖皮質激素(glucocorticoids,GCs)在重癥鑑護室(intensive care unit,ICU)治療急性呼吸窘迫綜閤徵(acute respiratory distress syndrome,ARDS)中的作用。方法迴顧性分析本院入住 ICU的 ARDS患者的臨床資料,併根據緻病因素在肺損傷中的作用,將所入選患者分為肺內源性 ARDS(primarily from pulmonary diseases, ARDSp)和肺外源性 ARDS(primarily from extra-pulmonary diseases,ARDSexp);ARDSp患者62例,ARDSexp患者101例。根據 GCs的使用量各分為3組,分析 ARDSp及 ARDSexp應用 GCs 和未應用 GCs 患者的病情改善和病死率。結果 ARDSp及 ARDSexp患者各組急性生理與慢性健康評分(Acute Physiology and Chronic Health EvaluationⅡ,APACHE-Ⅱ)相噹(P>0.05)。GCs治療<30 mg/d組與≥30 mg/d組比較,病情改善時間和呼吸機治療時間明顯縮短(P<0.01),病死率也略低(P>0.05);GCs治療<30 mg/d組與非 GCs治療組比較差異有統計學意義(P<0.01);≥30 mg/d組與非 GCs治療組比較差異無統計學意義(P>0.05)。ARDS患者總體病死率23.3%(38/163),其中使用 GCs治療組病死率22.8%(34/149),未使用 GCs治療組病死率28.6%(4/14)(P >0.05)。結論低劑量(<30 mg/d)、早期應用(24 h內)、長期療程(>7 d)的GCs,可及時遏製炎性介質的“瀑佈樣效應”,在一定程度上縮短病程,降低病死率。
목적:평개당피질격소(glucocorticoids,GCs)재중증감호실(intensive care unit,ICU)치료급성호흡군박종합정(acute respiratory distress syndrome,ARDS)중적작용。방법회고성분석본원입주 ICU적 ARDS환자적림상자료,병근거치병인소재폐손상중적작용,장소입선환자분위폐내원성 ARDS(primarily from pulmonary diseases, ARDSp)화폐외원성 ARDS(primarily from extra-pulmonary diseases,ARDSexp);ARDSp환자62례,ARDSexp환자101례。근거 GCs적사용량각분위3조,분석 ARDSp급 ARDSexp응용 GCs 화미응용 GCs 환자적병정개선화병사솔。결과 ARDSp급 ARDSexp환자각조급성생리여만성건강평분(Acute Physiology and Chronic Health EvaluationⅡ,APACHE-Ⅱ)상당(P>0.05)。GCs치료<30 mg/d조여≥30 mg/d조비교,병정개선시간화호흡궤치료시간명현축단(P<0.01),병사솔야략저(P>0.05);GCs치료<30 mg/d조여비 GCs치료조비교차이유통계학의의(P<0.01);≥30 mg/d조여비 GCs치료조비교차이무통계학의의(P>0.05)。ARDS환자총체병사솔23.3%(38/163),기중사용 GCs치료조병사솔22.8%(34/149),미사용 GCs치료조병사솔28.6%(4/14)(P >0.05)。결론저제량(<30 mg/d)、조기응용(24 h내)、장기료정(>7 d)적GCs,가급시알제염성개질적“폭포양효응”,재일정정도상축단병정,강저병사솔。
Objective To evaluate the effect of glucocorticoids (GCs ) in treatment of patients with acute respiratory distress syndrome (ARDS ) in intensive care unit (ICU ).Methods The clinical data were analyzed retrospectively from ARDS patients admitted to the ICU.In accordance with the role of virulence factors in lung injury, all the cases were divided into two large groups,patients with pulmonary ARDS group (ARDSp group)and patients with extrapulomonary ARDS group (ARDSexp group),ARDSp group had 62 cases and the other group had 101 cases. Then,the patients were subdivided into three smaller groups according to the dosage of GCs.Finally,the disease conditions and death rates among groups were analyzed.Results General conditions including Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)scores were similar between the two groups (P>0.05).The GCs <30 mg/d group showed a shorter time of improvement in patients ’ general condition and the days with mechanical ventilation support than those of the GCs≥30 mg/d group(P<0.01),and the death rate reduced slightly(P>0.05). The overall death rate of ARDS group was 23.3%(38/163).In GCs-use group,the rate was 22.8%(34/149),and in non GCs-use group,it was 28.6%(4/14)(P>0.05).Conclusion This research suggests that early therapy(<24 h), low dose(<30 mg/d)and long treatment GCs (>7 d)could help reverse serious inflammatory reaction,improve clinical symptoms and decrease death rate.