氢化可的松琥珀酸钠不同给药方式对重症脓毒性休克患者的影响

目的 研究氢化可的松琥珀酸钠静脉滴注和持续静脉微量泵入对重症脓毒性休克患者生命体征、休克 持续时间、血糖及病死率的影响.方法 选择2014年6月至2016年9月在该院重症医学科接受治疗的脓毒性休克患 者90例.用随机数表法分为对照组和观察组,每组各45例,对照组给予氢化可的松琥珀酸钠200 mg/d缓慢静脉 滴注2 h,观察组持续静脉微量泵入氢化可的松琥珀酸钠8.33 mg/h,两组连续治疗5 d.比较两组患者的血糖指 标、血流动力学和预后.结果 观察组患者的高血糖时间窗、最大血糖波动幅度、平均血糖水平、血糖波动系数 水平等血糖指标低于对照组,差异有统计学意义(P<0.05).两组患者治疗前、治疗后6 h、治疗后24 h和治 疗后5 d的心率、中心静脉压和平均动脉压等血流动力学指标比较,差异无统计学意义(P>0.05).观察组患 者的休克持续时间、ICU住院时间、总住院时间和28 d病死率低于对照组,但两组比较差异无统计学意义(P> 0.05).结论 持续静脉微量泵入氢化可的松琥珀酸钠可以稳定脓毒性休克患者的血糖波动幅度,但是血流动力 学指标和预后无明显改善.

Effects of different administration modes of hydrocortisone sodium succinate on patients with severe sepsis secondary shock

Objective To study the influence of hydrocortisone sodium succinct by intravenous infusion or continuous intravenous micro pumping on the vital signs,shock duration,blood glucose and mortality in the patients with severe sepsis secondary shock.Methods Ninety patients with septic shock treated in our hospital from June 2014 to September 2016 were selected and divided into the control group and observasion group by using the random number table method,45 cases in each group.The control group was given hydrocortisone sodium succinct 200mg/d by slow intravenous drip for 2h,while the observasion group was given hydrocortisone sodium succinct 8.33mg/h by continuous intravenous micro pumping.The two groups were treated for continuous 5 d.The blood glucose,hemodynamics and prognosis were compared between the two groups.Results In the observasion group,the blood glucose indicators such as the time window of high blood glucose,LAGE,MBG and CV levels were lower than those in the control group,the difference had statistical significance (P<0.05).The hemodynamic indicators such as HR,CVP and MAP between the two groups before treatment and at 6,24 h and 5 d after treatment had no statistical difference between the two groups (P>0.05).The shock duration,ICU stay length,total hospital stay and 28 d mortality in the observasion group were lower than those in the control group,but the difference between the two groups had no statistical significance (P>0.05).Conclusion Continuous intravenous micro pumping of hydrocortisone sodium succinct can stabilize blood glucose fluctuation range in the patients with septic shock,but the hemodynamic indexes and prognosis have no obvious improvement.