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目的探讨小剂量氢化可的松对脓毒性休克患者炎性反应的疗效。方法将脓毒性休克患者80例均予常规治疗。40例只行常规治疗(对照组);另40例加用小剂量氢化可的松治疗(氢可组)。治疗后4、12、24、48 h、7 d采用ELISA法测定血浆TNF-α,IL-1β,IL-6和IL-10含量;治疗前及后24、48 h、7 d行急性生理功能和慢性健康状况(APACHEⅡ)评分,并检测降钙素原(PCT)以及皮质醇浓度,记录28 d病死率。结果治疗前两组患者外周血上述指标水平差异无统计学意义。治疗前后比较,TNF-α、IL-1β和IL-6明显下降(P<0.05),IL-10差异无统计学意义;治疗24、48 h、7 d后APACHEⅡ评分下降(P<0.05)与对照组相比,在各时间点TNF-α,IL-1β,IL-6下降差异有统计学意义(P<0.05);APACHEⅡ评分降低(P<0.05),PCT下降(P<0.05),28 d病死率下降。但血皮质醇浓度与28 d生存率无明显相关性。结论小剂量氢化可的松能减轻脓毒性休克患者的炎症反应,改善预后。
Objective To investigate the effect of low-dose hydrocortisone on the inflammatory response in patients with septic shock. Methods 80 patients with septic shock were treated routinely. 40 cases were treated only routinely (control group); the other 40 cases were treated with low dose of hydrocortisone (hydrogen group). The plasma levels of TNF-α, IL-1β, IL-6 and IL-10 were measured by ELISA at 4, 12, 24, 48 and 7 days after treatment. Acute physiology And chronic health status (APACHE Ⅱ) score, and procalcitonin (PCT) and cortisol concentrations were recorded and the 28-day mortality was recorded. Results Before treatment, there was no significant difference in the above indexes between the two groups. The levels of TNF-α, IL-1β and IL-6 were significantly decreased before and after treatment (P <0.05), and there was no significant difference in IL-10 between the two groups (P <0.05) Compared with the control group, TNF-α, IL-1β and IL-6 decreased significantly at each time point (P <0.05), APACHEⅡscore decreased (P <0.05) d decreased mortality. However, there was no significant correlation between serum cortisol level and 28-day survival rate. Conclusion Low-dose hydrocortisone can reduce the inflammatory response and improve the prognosis of patients with septic shock.