不同剂量甲泼尼龙对急性呼吸窘迫综合征患者炎性因子及治疗效果的影响研究

目的探讨不同剂量甲泼尼龙对急性呼吸窘迫综合征(ARDS)患者炎性因子及治疗效果的影响。方法选取2010—2013年我院收治的ARDS患者60例,将其随机分为A、B、C 3组,各20例。3组患者均给予常规治疗,在常规治疗基础上B组患者给予甲泼尼龙80 mg/d静脉注射、C组患者给予甲泼尼龙500 mg/d静脉注射,疗程为3 d。观察3组患者治疗前、治疗后3 d和7 d血浆C反应蛋白(CRP)、纤维蛋白原(FIB)及降钙素原(PCT)水平变化,记录3组患者治疗前后氧合指数、急性生理和慢性健康评分系统Ⅱ评分(APACHEⅡ评分)、住院天数和病死率。结果治疗前3组患者CRP、FIB及PCT水平比较,差异无统计学意义(P0.05)。治疗后3 d和7 d B组和C组患者CRP、FIB及PCT水平低于A组,C组上述指标低于B组(P0.05)。治疗前3组患者氧合指数、APACHEⅡ评分比较,差异均无统计学意义(P0.05)。治疗后B组和C组氧合指数高于A组,C组高于B组(P0.05);APACHEⅡ评分低于A组,C组低于B组(P0.05);病死率和住院天数低于A组(P0.05)。结论甲泼尼龙治疗ARDS可以明显抑制患者炎性因子水平,有助于提高治疗效果,且较大剂量甲泼尼龙疗效更显著。

Effects of Different Doses of Methylprednisolone on Inflammatory Factors and Efficacy in Patients with Acute Respirato-ry Distress Syndrome

Objective To discuss the effect of different doses of Methylprednisolone on inflammatory factors and effica-cy in patients with acute respiratory distress syndrome（ARDS）. Methods 60 ARDS patients in our hospital from 2012 to 2013 were chosen,and they were randomly divided groups A,B,C,each of 20 cases. All patients were given conventional therapy, group B was given intravenous injection of Methylprednisolone,80 mg/ d,group C was given intravenous injection of Methylpred-nisolone,500 mg/ d. All patients treated for 3 days. The levels of C - reactive protein（CRP）,fibrinogen（FIB）and procalci-tonin（PCT）were detected before treatment,3 days and 7 days after treatment,and oxygenation index,APACHEⅡ score, hospitalization days and mortality were observed. Results Before treatment,there was no significant differences in the levels of CRP,FIB and PCT among the three groups（P 〉 0. 05）. 3 days and 7 days after treatment,the levels of CRP,FIB and PCT in groups B and C were lower than those of group A,group C were lower than those of group B（P 〈 0. 05）. Before treatment, there was no significant differences in oxygenation index,APACHEⅡ score among the three groups（P 〉 0. 05）. After treat-ment,the oxygenation index in groups B and C was higher than that of group A,group C were higher than that of group B（P 〈0. 05）;APACHEⅡ score were lower than that of group A,group C was lower than that of group B（P 〈 0. 05）;hospitalization days and mortality were lower than those of group A（P 〈 0. 05）. Conclusion Methylprednisolone can significantly inhibit the inflammatory factor,help to improve the therapeutic effect in patients with ARDS,and the effect of large dose of Methylpred-nisolone is better.