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目的:评价小剂量氢化可的松琥珀酸钠在治疗腹部手术后感染性休克患者的临床疗效。方法:选取2011年6月—2014年12月间确诊行腹部手术后感染性休克患者46例,将其随机分为观察组和对照组各23例,对照组患者围手术期给予常规处理,观察组患者在对照组患者治疗基础上加用氢化可的松琥珀酸钠100 mg治疗;评价两组患者治疗前后乳酸水平、乳酸清除率、APACHEⅡ评分值及患者休克恢复时间、ICU停留时间、不良反应的发生率和28 d病死率等临床疗效情况。结果:治疗前,两组患者乳酸浓度和APACHEⅡ评分值经比较其差异无统计学意义(P>0.05);治疗24 h、48 h后,观察组患者乳酸清除率为(46.2±8.1)%和(64.6±15.3)%均显著高于对照组为(30.1±7.9)%和(48.2±8.7)%,两组患者APACHEⅡ评分值均较治疗前显著下降且观察组治疗后显著低于对照组,差异均有统计学意义(P<0.05);观察组患者休克恢复时间(3.8±1.5)d和ICU停留时间(12.3±3.1)d均短于对照组(5.2±2.4)d和(19.2±4.3)d(P<0.05);前者28 d病死率为13.04%显著小于对照组为47.83%(P<0.05);两组患者不良反应的发生率经比较其差异无统计学意义(P>0.05)。结论:小剂量氢化可的松琥珀酸钠给予腹部手术患者术后感染性休克的治疗是安全的和有效的。
Objective: To evaluate the clinical efficacy of low-dose hydrocortisone sodium succinate in the treatment of patients with septic shock after abdominal surgery. Methods: Forty-six cases of septic shock were selected from June 2011 to December 2014. The patients were randomly divided into observation group (23 cases) and control group (23 cases). Patients in the control group were treated by perioperative period and observed Patients in the control group were treated with 100 mg hydrocortisone sodium succinate. The levels of lactic acid, lactic acid clearance, APACHE II score, recovery time of patients, ICU stay, adverse reactions The incidence and 28 d mortality and other clinical efficacy. Results: Before treatment, there was no significant difference in lactic acid concentration and APACHEⅡscore between the two groups (P> 0.05). After 24 and 48 hours of treatment, the lactic acid clearance rate in the observation group was (46.2 ± 8.1)% and (64.6 ± 15.3)% were significantly higher than that of the control group (30.1 ± 7.9)% and (48.2 ± 8.7)% respectively. APACHEⅡscore values of both groups were significantly lower than those before treatment and significantly lower than those of the control group (3.8 ± 1.5) d and ICU stay time (12.3 ± 3.1) d in observation group were significantly shorter than those in control group (5.2 ± 2.4) d and (19.2 ± 4.3), respectively ) (P <0.05). The former 28-day mortality was 13.04%, which was significantly lower than that of the control group (47.83%, P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05) . Conclusions: The treatment of septic shock with low-dose hydrocortisone sodium succinate in patients undergoing abdominal surgery is safe and effective.