小剂量氢化可的松在脓毒性休克治疗中的应用

目的 探讨小剂量氢化可的松对脓毒性休克患者炎性反应的疗效.方法 将脓毒性休克患者80例均予常规治疗.40例只行常规治疗(对照组);另40例加用小剂量氢化可的松治疗(氢可组).治疗后4、12、24、48 h、7 d采用ELISA法测定血浆TNF-α, IL-1β, IL-6和IL-10含量;治疗前及后24、48 h、7 d行急性生理功能和慢性健康状况(APACHEⅡ)评分,并检测降钙素原(PCT)以及皮质醇浓度,记录28 d病死率.结果 治疗前两组患者外周血上述指标水平差异无统计学意义.治疗前后比较, TNF-α、IL-1β和IL-6明显下降(P<0.05),IL-10差异无统计学意义;治疗24、48 h、7 d后APACHEⅡ评分下降(P<0.05)与对照组相比,在各时间点TNF-α,IL-1β,IL-6下降差异有统计学意义(P<0.05);APACHEⅡ评分降低(P<0.05),PCT下降(P<0.05),28 d病死率下降.但血皮质醇浓度与28 d生存率无明显相关性.结论 小剂量氢化可的松能减轻脓毒性休克患者的炎症反应,改善预后.

Effect of low dose hydrocortisone in treatment of patients with septic shock

Objective To study the effects of low-dose hydrocortisone on inflammatory response in the patients with septic shock.Methods 80 cases with septic shock were divided randomly into the treatment group and the contrast group.Both groups were treated by normal medicine and the treatment group by low-dose hydrocortisone additional injection.Plasma levels of TNF-α,IL-1β,IL-6,IL-10 were detected by ELISA respectively before（baseline）and at 4、12、24、48 h and 7 d after the treatment.APACHEⅡ score、PCT and cortisol were recorded before（baseline）and at 24、48 h and 7 d after the treatment.Mortality rate was compared on 28th day.Results The indexes of two groups were similar before treatment.TNF-α、IL-1β,IL-6 were significantly decreased compared with the baseline before the treatment（P0.05）,while there was no significant change in the plasma levels of IL-10,APACHEⅡ score were significantly decreased after the treatment（P0.05）.The levels of TNF-α,IL-1β and IL-6 at 4、12、24、48 h and 7 d after the treatment in treatment group were lower than those in control group at according time（P0.05）,the 28day mortality rate in the treatment group was significantly lower than the contrast group（P0.05）.While there were no association between cortisol levels and the 28day mortality rate.Conclusion Low-dose hydrocortisone can inhibit inflammatory response in patients with septic shock and improve the prognosis.