暴发型流脑并发休克糖皮质激素应用之探讨

目的探讨暴发型流行性脑脊髓膜炎(暴发型流脑)糖皮质激素应用价值以及治疗方案.方法 234例暴发型流脑住院患者,其中休克型149例、混合型85例.分成对照组和激素组.对照组给予常规综合治疗,激素组在常规综合治疗基础上加用氢化可的松或地塞米松.结果激素组体温下降至正常天数、血压恢复正常天数、脑膜刺激征消失天数、脱水剂使用天数均明显缩短;地塞米松更优于氢化可的松;激素对疾病的最终转归无影响.但应用大剂量地塞米松(成人每日≥40-mg,儿童≥1-mg*kg-1)增加外周血白细胞数、延长抗生素使用天数和住院天数,增加了各种并发症的发生率.结论暴发型流脑使用糖皮质激素尤其是常规剂量地塞米松静脉注射,对治疗脑水肿、稳定血压等方面有近期改善作用,不影响疾病最终转归;但增大剂量可增加各种副作用,对暴发型流脑病人不提倡大剂量皮质激素治疗.

Application of glucocorticoid in fulminant neisseria meningitis with shock

Objective To explore therapeutic significance of glucocorticoid for fulminant neisseria meningitis with shock.Methods 234 patients with fulminant meningitis,149 of 234 patients complicated with shock,other 85 patients complicated with shock and meningoencephalitis,were randomly divided into two groups, control and corticoid group,the former were treated with comprehensive routine treatment while for the latter hydrocortisone or dexamethasone were used besides the above treatment.Results In corticoid group, corticoid alleviated clinical symptoms but did not improve prognosis.The curative effect of dexamethasone was better than that of hydrocortisone.Supraphysiologic doses of dexamethasone increased complications.Conclusion Routine dose of corticoid may alleviate clinical symptoms,but does not improve prognosis.Supraphysiologic dose is not recommended for fulminant meningitis.