摘要
目的：探讨早期应用糖皮质激素（GC）治疗对急性呼吸窘迫综合征（ARDS）患者预后的影响。方法回顾性分析成都军区总医院2008年1月至2011年12月收治的所有ARDS病例的临床资料，选择符合2012年柏林ARDS诊断标准的成人患者，根据是否采用过GC治疗将患者分为GC组与非GC组。GC组患者均在ARDS发生48 h内开始静脉使用低剂量GC（＜5 mg·kg-1·d-1，均换算为氢化可的松的剂量）治疗，激素种类为甲泼尼松龙、地塞米松，疗程为7∽21 d；而非GC组为ARDS发生后未使用GC治疗。比较两组患者机械通气时间、重症加强治疗病房（ICU）住院时间、总住院时间、医疗费用和28 d生存率的差异。结果共纳入ARDS患者117例，其中GC组56例（占47.86%），非GC组61例（占52.14%）。与非GC组比较，GC组机械通气时间明显缩短〔d：0（0，2.50）比2.00（0，2.50），Z＝2.015，P＝0.044〕，28 d生存率明显升高〔71.43%（40/56）比50.82%（31/61），χ2＝5.198，P＝0.023〕，ICU住院时间〔d：7.50（2.00，11.00）比4.00（1.00，9.00），Z＝1.879， P＝0.060〕和总住院时间〔d：16.00（10.00，27.75）比15.00（7.00，28.00），Z＝0.592，P＝0.552〕差异无统计学意义，但非GC组患者的医疗费用显著低于GC组〔万元：3.15（1.51，5.78）比4.39（1.66，10.88），Z＝2.204，P＝0.028〕。结论早期使用GC治疗ADRS患者可改善预后，特别是28 d生存率。
Objective To explore the effects of early glucocorticoids （GC） therapy on the outcome of patients with acute respiratory distress syndrome （ARDS）. Methods The clinical data of all ARDS patients admitted from January 2008 to December 2011 in Chengdu Military General Hospital of Chinese PLA were retrospectively analyzed. The adult patients whose diagnosis was in accord to the Berlin ARDS diagnostic criteria published in 2012 were enrolled, and based on whether using glucocorticoid or not, they were divided into GC group and non-GC group. All the patients in GC group received low dosage of intravenous GC within 48 hours after the onset of ARDS, including different kinds of GC, methylprednisolone, dexamethasone and hydrocortisone （hydrocortisone dosage 〈 5 mg·kg-1·d-1, the dosage of former two kinds of GC being converted to that of hydrocortisone）, and the therapeutic course of the two groups was 7 to 21 days. The patients in non-GC group received no GC therapy after the occurrence of ARDS. The duration of mechanical ventilation, the length of intensive care unit （ICU） stay and totally in hospital, medical cost and 28-day survival rate were compared between the two groups. Results One hundred and seventeen patients with ARDS were collected, including 56 cases （47.86%） in GC group and 61 cases （52.14%） in non-GC group. The duration of mechanical ventilation in GC group was significantly shorter than that in non-GC group [days：0 （0, 2.50） vs. 2.00 （0, 2.50）, Z=2.015, P=0.044]. The 28-day survival rate in GC group was significantly higher than that in non-GC group [71.43%（40/56） vs. 50.82%（31/61）,χ2=5.198, P=0.023]. There were no significant differences in the length of ICU stay [days：7.50 （2.00, 11.00） vs. 4.00 （1.00, 9.00）, Z=1.879, P=0.060] and stay totally in hospital [days：16.00 （10.00, 27.75） vs. 15.00 （7.00, 28.00）, Z=0.592, P=0.552] between GC group and non-GC group. However, the medical cost in non-GC group was significant lower than that in GC group [10 thousand Chinese yuan：3.15 （1.51, 5.78） vs. 4.39 （1.66, 10.88）, Z=2.204, P=0.028]. Conclusion The early GC therapy may improve the outcome of patients with ARDS, especially beneficial to the 28-day survival rate.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2015年第1期83-85,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
成都军区“十二五”项目（C12034）
成都军区总医院院管项目（2012YG-B23）
关键词
糖皮质激素
急性呼吸窘迫综合征
预后
Glucocorticoids
Acute respiratory distress syndrome
Outcome
作者简介
通讯作者：李晓华，Email：383152721@qq．com
