糖皮质激素在急性呼吸窘迫综合征综合救治中的价值探讨

目的：探讨糖皮质激素(GC)在急性呼吸窘迫综合征(ARDS)综合救治中的价值。方法：前瞻性收集2000年5月-2002年8月收入ICU所有ARDS患者的临床资料，依据是否应用GC，将患者分为GC与非GC组，统计分析两组年龄、性别、原发病、急性生理与慢性健康状况评分(APACHE Ⅱ)、氧合指数(PaO2／FiO2)、肺内分流(Qs／Qt)、机械通气、呼气末正压(PEEP)水平、病死率与直接死亡原因；同时还分析了GC组应用GC时机、剂量、疗程等对预后的影响。结果：77例患者中，GC组60例，非GC组17例，两组性别、年龄、APACHE Ⅱ评分、PaO2／FiO2与Qs／Qt、机械通气时间、PEEP水平、缺氧改善情况等均无显著差异(P均＞0．05)；消化道出血发生率与血浆肿瘤坏死因子—α(TNF—α)水平两组无显著差异(P均＞0．05)；GC组病死率(71．7％)高于非GC组(52．9％)，但无统计学差异(P＞0．05)；两组因ARDS所致病死率均低(7．0％和11．1％)；GC组死亡患者的年龄、APACHE Ⅱ评分、基础疾病等方面与存活患者差异显著(P＜0．001或P＜0．005)，住院时间也短(P＜0．05)；确诊前与确诊后24h内应用GC患者的病死率(66．7％和68．2％)低于确诊24h后应用GC的患者(90．0％)。结论：GC是ARDS综合救治的措施之一，一旦出现顽固性缺氧与休克时，应及时应用GC。

Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome

OBJECTIVE: To value of glucocorticoid (GC) in treatment for patients with acute respiratory distress syndrome (ARDS) was evaluated. METHODS: The clinical data from all patients with ARDS in medical ICU (MICU) during May 2000 to Aug. 2002 were collected. They were divided into two groups, GC and non-GC groups, in order to compare their age, sex, acute physiology and chronic health evaluation II (APACHE II) score, PaO2/FiO2, Qs/Qt, level of positive end-expiratory pressure(PEEP), mortality and dead reason of death, depending on whether GC was given or not. In cases with administration of GC, the dosage, as well as duration of treatment was analyzed in terms of the overcome. RESULTS: There were 77 cases totally, among them 60 cases were of GC group and 17 of non -GC. Their age, sex, APACHE II score, PaO2/FiO2, Qs/Qt, use of artificial ventilation and its duration, level of PEEP, and the extent of relief from hypoxemia showed no significant differences between two groups (P>0.05). Even the mortality for patients who were treated with GC was higher than those without (71.7% vs. 52.9%), though there was no statistically significant difference (P>0.05). The percentage of patients died primarily of ARDS was low in both groups (7.0% and 11.1%). The age, APACHE II score and underlying diseases for non-survivors were older and higher than survivors (P<0.001 or P<0.005) and their duration of staying in ICU was shorter than the latter (P<0.05). The mortality of patients who were given GC before or during 24 hours of the establishment of the diagnosis of ARDS (66.7% and 68.2%) was lower than those who were given GC 24 hours after the diagnosis of ARDS (90.0%). CONCLUSION: GC could be one of effective treatments for ARDS, and it should be given without hesitation when refractory hypoxemia and shock were found.