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目的 :探讨严重急性呼吸综合征 (severeacuterespiratorysyndrome,SARS)治疗中糖皮质激素 (glucocorti costeroids ,GCS)的使用与不良反应的关系。方法 :收集北京市SARS病历资料 ,建立数据库 ,回顾分析 12 91例临床诊断SARS病例。按照GCS起始剂量、日最大剂量和累积剂量分组 ,均换算为甲泼尼龙 (methyprednisonlone,MP)剂量。使用SAS 8.10软件统计GCS相关不良反应 ,包括血糖增高 (≥ 7.8mmol/L)、低钾血症 (<3.5mmol/L)、低钙血症 (<2 .12mmol/L)、收缩压升高 [≥ 14 0mmHg(1mmHg =0 .133kPa) ]及舒张压升高 (≥ 90mmHg)。结果 :GCS组 10 84例 ,未用GCS组 2 0 7例。GCS平均日使用剂量总趋势是递减 ,早期日平均剂量 (中位数 )为 16 0mg/d ,10天后下降 ,13天降到 80mg/d。GCS组病程中最高血糖 (8.6 8± 4 .80 )mmol/L ,未用GCS组 (6 .39± 3.71)mmol/L ,两组比较差异有显著性 (P <0 0 0 1)。MP起始 ≥ 80mg/d ,MP最大 ≥ 16 0mg/d以及MP累积 ≥ 30 0 0mg各组的平均血糖均明显升高。使用GCS后第 1～ 2周血糖升高最显著 ,而后逐渐下降。MP累积 ≥ 30 0 0mg组血糖增高且持续时间延长 ,与其它组比较差异有显著性 (P <0 .0 5 )。GCS组病程中最低血钾为 (3.6 6± 0 .5 0 )mmol/L ,低钾持续时间 1(1,75 )天 ,与?
Objective: To investigate the relationship between the use of glucocorti costeroids (GCS) and adverse reactions in the treatment of severe acute respiratory syndrome (SARS). Methods: The data of SARS cases in Beijing were collected and the database was established. A total of 1291 cases of SARS were retrospectively analyzed. According to GCS initial dose, daily maximum dose and cumulative dose group, are converted to methylprednisolone (methyprednisonlone, MP) dose. GCS-related adverse effects including SAS (≥ 7.8 mmol / L), hypokalemia (<3.5 mmol / L), hypocalcemia (<2.12 mmol / L) [≥ 140 mmHg (1 mmHg = 0.133 kPa)] and increased diastolic blood pressure (≥ 90 mmHg). Results: There were 10 84 cases in the GCS group and 270 cases in the GCS group. The overall average daily dose of GCS tended to decrease, with an average early daily dose of 160 mg / d, a decline after 10 days and a reduction to 80 mg / day on day 13. In the GCS group, the highest blood glucose (8.68 ± 4.80 mmol / L) and no GCS group (6.39 ± 3.71 mmol / L) were significantly different between the two groups (P <0.01). The average blood glucose in all groups with MP≥80mg / d, MP≥160mg / d and MP≥30〇0mg increased significantly. After using GCS 1 to 2 weeks after the most significant increase in blood glucose, and then gradually decreased. MP accumulation ≥ 30 0mg group increased blood glucose and duration, compared with the other groups, the difference was significant (P <0.05). The lowest potassium level in the GCS group was (3.6 6 ± 0. 50) mmol / L and the duration of hypokalemia was 1 (1,75) days,