糖皮质激素治疗严重急性呼吸综合征氧合指数的变化

目的 了解糖皮质激素在治疗SARS过程中对改善肺氧合功能的影响.方法 回顾性分析2003年SARS病例225例,氧合指数作为糖皮质激素疗效的判别指标,有效的标准是治疗后氧合指数较治疗前上升≥20%.采用方差分析、X2检验分析糖皮质激素的疗效.结果 225例中有134例(59.6%)SARS患者在治疗中使用糖皮质激素;所有患者糖皮质激素(静脉给药)治疗前氧合指数的平均水平为237.08 mm Hg.治疗后为335.08 mm Hg,平均升高110.26 mm Hg,升幅为46.4%;96例有血气分析结果的SARS患者中,符合应用指征的有85例(88.5%),糖皮质激素治疗后氧合指数平均升高103.14 mm Hg,升幅为44.4%,低于无应用指征的190.91 mm Hg,升幅为66.8%,两组差异无统计学意义;糖皮质激素治疗前后氧合指数差值随治疗前氧合指数水平升高而下降,治疗前氧合指数≥300 mm Hg组升高最少,升幅为5.6%.结论在SARS治疗中,适当应用糖皮质激素,对减轻患者肺部症状、改善肺功能有一定疗效,特别是对于符合急性肺损伤或急性呼吸窘迫综合征(ARDS)诊断、治疗前氧合指数水平较低患者(氧合指数＜300 mm Hg)的肺功能改善更明显.

Changes of oxygenation index of severe acute respiratory syndrome treated with glucocorticosteroids

Objective To investigate the effect of glucocorticosteroids on pulmonary oxygenation function in severe acute respiratory syndrome(SARS)patients.Methods Two hundred and twenty-five SARS patients in 2003 were analyzed retrospectively.Oxygenation index(OI)was considered as the marker of glucocorticosteroids therapeutic effects.The criteria of effectiveness was that OI increased 20%or more than pre-treatment.The therapeutic effects of glueocorticosteroids were analyzed by analysis of variance and chi-square test.Results Glucocorticosteroids were used in 59.6%(134/225)of SARS cases.The average OI before and after glucocorticosteroids intravenous treatment was 237.08 mm Hg and 335.08 mm Hg,respectively.The average OI increased 110.26 mm Hg(46.4%)after treatment.In 96 SARS patients whose blood gas analysis results were available,85 cases(88.5%)had administrative indication.The average OI increased 103.14 mm Hg(44.4%),which was lower than 190.91 mm Hg(66.8 0A)in patients without administrative indication.There was no significant difference between these two groups of patients.The OI difference before and after glueocorticosteroids treatment was decreased with the increasing OI before treatment,the increase was minimum in patients with OI≥300 mm Hg.Conclusions The SARS patients could obtain pulmonary symptoms and function improvements with appropriate glucoconicosteroids treatment,especially for those who are in accord with acute lung injure or acute respiratory distress syndrome,and OI less than 300 mm Hg before treatment.