糖皮质激素治疗3例重/危重型COVID-19患者有效性及安全性分析

目的：初步评估糖皮质激素治疗重/危重型COVID-19患者的有效性及安全性。方法：通过回顾性分析3例重/危重型COVID-19患者激素使用指征、使用时机、用法用量及疗程和不良反应，对比患者使用激素前后症状、体征，炎症因子、血氧饱和度、氧合指数及影像学等变化，分析激素使用的有效性和安全性。结果：有效性方面：3例患者有激素使用指征且使用后症状体征有一定好转，影像学有吸收；患者C病情反复并进行了气管插管。安全性方面：3例患者均出现了血糖升高；患者B的乙肝病毒被激活并继发了糠秕孢子菌毛囊炎；患者C细菌感染加重并出现了异常躁动。3例患者的排毒时间均大于35天，其中患者B排毒时间最长，为44.67天；3例患者住院时间均超过1个月，B患者长达47.46天。结论：激素应用是把双刃剑，应严格掌握使用指征和疗程，权衡利弊，重视激素使用后的不良反应。

Analysis of the Efficacy and Safety of Glucocorticoids in 3 Patients with Severe/Critical COVID-19

Objective: Initially evaluate the efficacy and safety of glucocorticoids in the treatment of severe/critically severe COVID-19 patients. Methods: Through retrospective analysis of 3 cases of severe/critically severe COVID-19 patients with hormone use indications, timing, usage, dosage and treatment duration and adverse reactions, compare the changes in symptoms and signs, inflammatory factors, blood oxygen saturation, oxygenation index and imaging of patients before and after the use of hormones, analyze the effectiveness and safety of hormone use. Results: In terms of effectiveness: Three patients had signs of hormone use and their symptoms and physical characteristics improved after use, and radiography was absorbed; Patient C''s condition was repeated and tracheal intubation was performed; In terms of safety: all three patients had elevated blood glucose; Patient B''s hepatitis B virus was activated and developed pityrosporum folliculitis; Patient C had an increased bacterial infection and developed abnormal restlessness. The detoxification time of all three patients was greater than 35 days, among which patient B had the longest detoxification time of 44.67 days; The hospitalization time of the three patients was also more than 1 month, and patient B was up to 47.46 days. Conclusion: The application of hormones is a double-edged sword. The indications and treatment course should be strictly controlled, the pros and cons should be weighed, and the adverse reactions after hormone use should be emphasized.