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目的探讨糖皮质激素在传染性非典型肺炎(SARS)治疗中的作用。方法对409例SARS患者进行回顾性研究。根据激素使用与否、剂量及开始使用时间分组,分别比较普通型及重症患者各组在临床经过和预后上的差异。结果普通型中:①使用激素者的发热天数、病灶吸收时间较未用者长②未用激素者CD4+T细胞维持高于使用激素者水平;③未用激素组中无机械通气者,而激素治疗组中均有无创机械通气患者,>160mg组中占18.6%,显著高于其他两剂量组。重症中:①在病程8d以后开始用激素的患者的发热天数较1周内用激素者长。>80mg/d的激素两组呼吸道症状持续时间较长;②病灶吸收时间在各组中无显著差异;③在3d内即接受激素治疗者,不吸氧的比例高于未用激素者及8d后用激素者;>160mg/d组中需接受机械通气的患者明显高于未用激素者和其他2个剂量组;④>160mg/d组的预后显著差于其他组;激素开始使用时间对治愈率或死亡率无显著影响。结论早期激素治疗可以在一定程度上改善重症患者的氧合,控制发热,但仍应严格掌握适应证,合理应用。
Objective To investigate the role of glucocorticoids in the treatment of SARS. Methods A total of 409 SARS patients were retrospectively studied. According to the use of hormones or not, the dose and time to start using grouping were compared in general and critically ill patients in each group in the clinical course and prognosis differences. The results of the common type: ① the use of hormones fever days, the lesion absorption time longer than those who did not use hormone ② CD4 + T cells maintained higher than the level of those who use hormones; ③ hormone group without mechanical ventilation, and Patients in the hormone therapy group had noninvasive mechanical ventilation, accounting for 18.6% of the patients in the group of> 160 mg, significantly higher than the other two dose groups. Severe: ① 8d in the course of the disease began to use hormones in patients with fever days than those who use hormones longer. > 80mg / d hormones longer duration of respiratory symptoms in both groups; ②take time of lesions in each group was no significant difference; ③ within 3d that hormone therapy, non-oxygen ratio was higher than those without hormones and 8d After the use of hormones;> 160mg / d group required mechanical ventilation was significantly higher than those without hormones and other two dose groups; ④> 160mg / d group, the prognosis was significantly worse than the other groups; hormone start time No significant effect on cure or mortality. Conclusion Early hormone therapy can improve oxygenation and control fever in critically ill patients to some extent. However, indications should be strictly followed and applied reasonably.