中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2015年
1期
83-85
,共3页
肖贞良%周菁%陈章%吴奎%李晓华
肖貞良%週菁%陳章%吳奎%李曉華
초정량%주정%진장%오규%리효화
糖皮质激素%急性呼吸窘迫综合征%预后
糖皮質激素%急性呼吸窘迫綜閤徵%預後
당피질격소%급성호흡군박종합정%예후
Glucocorticoids%Acute respiratory distress syndrome%Outcome
目的:探讨早期应用糖皮质激素(GC)治疗对急性呼吸窘迫综合征(ARDS)患者预后的影响。方法回顾性分析成都军区总医院2008年1月至2011年12月收治的所有ARDS病例的临床资料,选择符合2012年柏林ARDS诊断标准的成人患者,根据是否采用过GC治疗将患者分为GC组与非GC组。GC组患者均在ARDS发生48 h内开始静脉使用低剂量GC(<5 mg·kg-1·d-1,均换算为氢化可的松的剂量)治疗,激素种类为甲泼尼松龙、地塞米松,疗程为7~21 d;而非GC组为ARDS发生后未使用GC治疗。比较两组患者机械通气时间、重症加强治疗病房(ICU)住院时间、总住院时间、医疗费用和28 d生存率的差异。结果共纳入ARDS患者117例,其中GC组56例(占47.86%),非GC组61例(占52.14%)。与非GC组比较,GC组机械通气时间明显缩短〔d:0(0,2.50)比2.00(0,2.50),Z=2.015,P=0.044〕,28 d生存率明显升高〔71.43%(40/56)比50.82%(31/61),χ2=5.198,P=0.023〕,ICU住院时间〔d:7.50(2.00,11.00)比4.00(1.00,9.00),Z=1.879, P=0.060〕和总住院时间〔d:16.00(10.00,27.75)比15.00(7.00,28.00),Z=0.592,P=0.552〕差异无统计学意义,但非GC组患者的医疗费用显著低于GC组〔万元:3.15(1.51,5.78)比4.39(1.66,10.88),Z=2.204,P=0.028〕。结论早期使用GC治疗ADRS患者可改善预后,特别是28 d生存率。
目的:探討早期應用糖皮質激素(GC)治療對急性呼吸窘迫綜閤徵(ARDS)患者預後的影響。方法迴顧性分析成都軍區總醫院2008年1月至2011年12月收治的所有ARDS病例的臨床資料,選擇符閤2012年柏林ARDS診斷標準的成人患者,根據是否採用過GC治療將患者分為GC組與非GC組。GC組患者均在ARDS髮生48 h內開始靜脈使用低劑量GC(<5 mg·kg-1·d-1,均換算為氫化可的鬆的劑量)治療,激素種類為甲潑尼鬆龍、地塞米鬆,療程為7~21 d;而非GC組為ARDS髮生後未使用GC治療。比較兩組患者機械通氣時間、重癥加彊治療病房(ICU)住院時間、總住院時間、醫療費用和28 d生存率的差異。結果共納入ARDS患者117例,其中GC組56例(佔47.86%),非GC組61例(佔52.14%)。與非GC組比較,GC組機械通氣時間明顯縮短〔d:0(0,2.50)比2.00(0,2.50),Z=2.015,P=0.044〕,28 d生存率明顯升高〔71.43%(40/56)比50.82%(31/61),χ2=5.198,P=0.023〕,ICU住院時間〔d:7.50(2.00,11.00)比4.00(1.00,9.00),Z=1.879, P=0.060〕和總住院時間〔d:16.00(10.00,27.75)比15.00(7.00,28.00),Z=0.592,P=0.552〕差異無統計學意義,但非GC組患者的醫療費用顯著低于GC組〔萬元:3.15(1.51,5.78)比4.39(1.66,10.88),Z=2.204,P=0.028〕。結論早期使用GC治療ADRS患者可改善預後,特彆是28 d生存率。
목적:탐토조기응용당피질격소(GC)치료대급성호흡군박종합정(ARDS)환자예후적영향。방법회고성분석성도군구총의원2008년1월지2011년12월수치적소유ARDS병례적림상자료,선택부합2012년백림ARDS진단표준적성인환자,근거시부채용과GC치료장환자분위GC조여비GC조。GC조환자균재ARDS발생48 h내개시정맥사용저제량GC(<5 mg·kg-1·d-1,균환산위경화가적송적제량)치료,격소충류위갑발니송룡、지새미송,료정위7~21 d;이비GC조위ARDS발생후미사용GC치료。비교량조환자궤계통기시간、중증가강치료병방(ICU)주원시간、총주원시간、의료비용화28 d생존솔적차이。결과공납입ARDS환자117례,기중GC조56례(점47.86%),비GC조61례(점52.14%)。여비GC조비교,GC조궤계통기시간명현축단〔d:0(0,2.50)비2.00(0,2.50),Z=2.015,P=0.044〕,28 d생존솔명현승고〔71.43%(40/56)비50.82%(31/61),χ2=5.198,P=0.023〕,ICU주원시간〔d:7.50(2.00,11.00)비4.00(1.00,9.00),Z=1.879, P=0.060〕화총주원시간〔d:16.00(10.00,27.75)비15.00(7.00,28.00),Z=0.592,P=0.552〕차이무통계학의의,단비GC조환자적의료비용현저저우GC조〔만원:3.15(1.51,5.78)비4.39(1.66,10.88),Z=2.204,P=0.028〕。결론조기사용GC치료ADRS환자가개선예후,특별시28 d생존솔。
Objective To explore the effects of early glucocorticoids (GC) therapy on the outcome of patients with acute respiratory distress syndrome (ARDS). Methods The clinical data of all ARDS patients admitted from January 2008 to December 2011 in Chengdu Military General Hospital of Chinese PLA were retrospectively analyzed. The adult patients whose diagnosis was in accord to the Berlin ARDS diagnostic criteria published in 2012 were enrolled, and based on whether using glucocorticoid or not, they were divided into GC group and non-GC group. All the patients in GC group received low dosage of intravenous GC within 48 hours after the onset of ARDS, including different kinds of GC, methylprednisolone, dexamethasone and hydrocortisone (hydrocortisone dosage < 5 mg·kg-1·d-1, the dosage of former two kinds of GC being converted to that of hydrocortisone), and the therapeutic course of the two groups was 7 to 21 days. The patients in non-GC group received no GC therapy after the occurrence of ARDS. The duration of mechanical ventilation, the length of intensive care unit (ICU) stay and totally in hospital, medical cost and 28-day survival rate were compared between the two groups. Results One hundred and seventeen patients with ARDS were collected, including 56 cases (47.86%) in GC group and 61 cases (52.14%) in non-GC group. The duration of mechanical ventilation in GC group was significantly shorter than that in non-GC group [days:0 (0, 2.50) vs. 2.00 (0, 2.50), Z=2.015, P=0.044]. The 28-day survival rate in GC group was significantly higher than that in non-GC group [71.43%(40/56) vs. 50.82%(31/61),χ2=5.198, P=0.023]. There were no significant differences in the length of ICU stay [days:7.50 (2.00, 11.00) vs. 4.00 (1.00, 9.00), Z=1.879, P=0.060] and stay totally in hospital [days:16.00 (10.00, 27.75) vs. 15.00 (7.00, 28.00), Z=0.592, P=0.552] between GC group and non-GC group. However, the medical cost in non-GC group was significant lower than that in GC group [10 thousand Chinese yuan:3.15 (1.51, 5.78) vs. 4.39 (1.66, 10.88), Z=2.204, P=0.028]. Conclusion The early GC therapy may improve the outcome of patients with ARDS, especially beneficial to the 28-day survival rate.