小剂量糖皮质激素治疗AECOPD合并CIRCI对血清炎症因子及临床疗效的影响
Clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol
付海卫 1李小波 1孔一名 1张添威 1戴元荣2
作者信息
- 1. 温州医科大学附属黄岩医院 呼吸内科,浙江 台州 318020
- 2. 温州医科大学附属第二医院 呼吸科,浙江 温州 325027
- 折叠
摘要
目的 探讨小剂量糖皮质激素治疗感染性休克、急性呼吸窘迫综合征以及慢性阻塞性肺疾病的急性加重期(AECOPD)合并危重症疾病相关性皮质醇不足(CIRCI)对血清炎症因子及临床疗效的影响.方法 72例AECOPD患者合并危重症疾病相关性皮质醇不足(CIRCI)患者随机分为对照组和试验组,每组36例,2组均给予常规治疗以及对症治疗,对照组给予氢化可的松100mg+5%葡萄糖注射液500mL静脉注射;试验组给予氢化可的松50mg+5%葡萄糖注射液500mL静脉注射,每天3次.2组1个周期均为7d,持续用药3个周期.对2组临床疗效、治疗前后血清炎症因子C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)水平进行观察,采用全自动生化分析仪记录并检测用力肺活量(FVC)、第1秒用力呼出量(FEV1)、FEV1/FVC,同时对比临床疗效及不良反应发生情况.结果 治疗后,对照组临床总有效率为77.78%,显著低于试验组的94.44%(P<0.05).2 组治疗后血清CRP、IL-6、TNF-α、PCT水平均显著降低,且试验组显著小于对照组(P<0.05);血清FVC、FEV1、FEV1/FVC水平均显著升高,且试验组显著大于对照组(P<0.05).对照组不良反应发生率为16.67%,试验组为8.33%,差异无统计学意义.结论 小剂量糖皮质激素可使AECOPD合并危重症疾病患者的临床疗效得到提高,显著降低炎症因子的水平,促进肺功能的改善.
Abstract
Objective To explore clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol.Methods72 patients with AECOPD in our hospital were randomly divided into control group and treatment group.The control group was treated with conventional AECOPD method,the treatment group was treated on the base of the treatment group with a small dose of corticosteroids,CRP, IL-6, TNF-α, FEV1, PCT and other indicators, as well as patients with ventilation, shock and mortality were compared after the end of treatment.ResultsThe time of non mechanical ventilation, the time of non-mechanical ventilation, and the time of non-shock were increased, the shock and the mortality was lower in the treatment group,(P<0.05);The CRP level of patients in the treatment group was lower(P<0.05);IL-6, TNF-α, PCT levels of patients in the treatment group was lower (P<0.05);FEV1, FVC and FEV1/FVC level in the treatment group were higher(P<0.05).ConclusionSmall dose glucocorticoid can improve the pulmonary function of patients with AECOPD complicated by severe disease, and alleviate the disease, significantly reduce the levels of inflammatory factors, promote the improvement of the lung function.
关键词
小剂量糖皮质激素/AECOPD/血清炎症因子/危重症疾病相关性皮质醇不足(CIRCI)/疗效Key words
small dose of glucocorticoid/AECOPD/critical illness related cortisol deficiency/efficacy引用本文复制引用
出版年
2017
NETL
NSTL
维普
万方数据