糖皮质激素在老年患者蝮蛇咬伤致全身炎症反应综合征及多器官功能损伤中的应用价值

目的探讨小剂量氢化可的松琥珀酸钠在老年患者蝮蛇咬伤全身炎症反应综合征（SIRS）及多器官功能损伤中的应用价值。方法采用前瞻性研究方法，选择2009年4月至2013年4月我科收治的合并SIRS和多器官功能受损的蝮蛇咬伤老年患者60例，随机分为对照组和治疗组（n=30），两组均给予常规程序化治疗，治疗组加用小剂量氢化可的松琥珀酸钠，测定两组患者治疗前及治疗后1，3，5d的炎症相关指标及血生化指标。结果治疗前两组各项指标比较，差异均无统计学意义（P〉0．05）。与治疗前比较，对照组肌酸激酶（CK）和肌酸激酶同工酶（CK—MB）治疗后第3天差异有统计学意义（P〈0．05），体温（T）、脉搏（P）、白细胞计数（WBC）、C反应蛋白（CRP）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和乳酸脱氢酶（LDH）第5天出现统计学差异（P〈0．05）；治疗组T，CK和CK-MB在第1天时差异即有统计学意义（P〈0．05），WBC，CRP，AST，ALT和LDH在第3天时差异有统计学意义（P〈0．05）。治疗组与对照组间各项指标比较，3d时CK和CK-MB差异有统计学意义（P〈0．05），5d时AST，ALT和LDH差异有统计学意义（P〈0．05）。结论小剂量氢化可的松琥珀酸钠能减轻老年患者蝮蛇咬伤的炎症反应，对重要器官的功能有一定的保护作用。

Glucocorticoid for treatment of systemic inflammatory reaction syndrome and multiple-organ functional impairment in elderly patients after viper snake bite

Objective To investigate the value of small dose of hydrocortisone sodium succinate in the treatment of systemic inflammatory reaction syndrome（SIRS） and multiple organ functional impairment in the elderly patients after viper snake bite. Methods A prospective trial was conducted on 60 elderly patients with SIRS and multiple organ functional impairment after viper snake bite admitted in our department from April 2009 to April 2013. They were randomly allocated into a control and a treatment group, with 30 patients in each group. Conventional treatment procedures were given to the patients in both groups. Additional low-dose of hydrocortisone sodium succinate was used to the patients in the treatment group. Inflammation-related indicators and clinical biochemical indices were determined for those patients before and in 1, 3, and 5d after the treatment. Results Before the treatment, there was no significant difference in above indicators between the 2 groups（P 〉 0.05）. In the control group, significant differences were found in creatine kinase（CK） and CK isoenzyme（CK-MB） levels at 3d after the treatment and before the treatment（P 〈 0.05）. While the differences in temperature（T）, pulse（P）, white blood cell（WBC）, C-reactive protein（CRP）, aspartate transaminase（AST）, alanine transaminase（ALT） and lactate dehydrogenase（LDH） levels were seen at 5d after the treatment（P 〈 0.05）. In the treatment group, the differences in T, and levels of CK and CK-MB were found at ld after the treatment（P 〈 0.05）, while those in WBC, CRP, AST, ALT and LDH levels were seen at 3d after the treatment（P 〈 0.05）. Comparing the results from the control and the treatment groups, the statistical significant differences in CK and CK-MB levels appeared at 3d after treatment（P 〈 0.05）, while those in AST, ALT and LDH levels at 5dafter treatment（P 〈 0.05）. Conclusion Low dose of hydrocortisone sodium succinate attenuates SIRS in the elderly patients after viper snake bite, and exerts protective effect on the functions of important organs.