方丽,管亚慧,林凤,李春棠,唐忠平
FANG Li,GUAN Yahui,LIN Feng,LI Chuntang,TANG Zhongping

• 1:贵阳市第一人民医院重症医学科

摘要(Abstract)：

目的:探讨小剂量糖皮质激素对脓毒症血清C-反应蛋白(CRP)、血清降钙素原(PCT)水平及预后的影响。方法:选取严重脓毒症患者47例,随机分为小剂量糖皮质激素治疗组及对照组,治疗组在对照组基础上加用氢化泼尼松1 mg/(kg·d),24 h静脉泵入7 d;观察2组患者治疗前、治疗后第6、24、48 h、第3、5、7天的血清CRP、PCT浓度,并比较2组患者平均动脉压(MAP)、治疗前后急性生理和慢性健康评分(APACHEⅡ)、多器官功能不全综合征(MODS)发生率及住ICU时间。结果:治疗组在治疗后第24、48 h、第3天及第7天血清CRP较对照组低,第5天时更明显(P<0.05,P<0.01);治疗组在治疗后第6、24、48 h血清PCT较对照组低(P<0.05),第3、5、7天时更明显(P<0.05,P<0.01);治疗后6 h时MAP较对照组提高(P<0.05),APACHEⅡ评分较对照组改善明显(P<0.05),MODS发生率低于对照组(P<0.05),两组患者住ICU时间比较,差异无统计学意义(P>0.05)。结论:小剂量糖皮质激素治疗能够降低脓毒症患者血清CRP、PCT浓度,能较早逆转休克,改善患者APACHEⅡ评分及MDOS发生率,但在治疗时间上并未显示其优势。
Objective: To investigate the effect of low doses of glucocorticoid on serum C-reactive protein( CRP) and serum procalcitonin( PCT) in sepsis patients. Methods: Forty-seven patients with severe sepsis were selected and divided into low dose glucocorticoid treatment group and control group randomly. The serum CRP and PCT levels were observed before treatment,and 6 h,24 h,48 h,3and 5 days after treatment. The mean arterial pressure( MAP),acute physiology and chronic health evaluation( APACHE Ⅱ),incidence of multiple organ dysfunction syndrome( MODS) and the stay time in ICU between the two groups were compared. Results: In 24 h,48 h,3 and 5 days after treatment,the treatment group's serum levels of CRP were lower than those of control group( P < 0. 05),and the lowest point of serum CRP level appeared on the fifth day( P < 0. 01). In 6 h,24 h and 48 h after treatment,the treatment group's serum PCT levels were lower than those of control group( P <0. 05),and they were specially lower in 3,5,and 7 days after treatment( P < 0. 01). In treatment group,MAP in 6 h after treatment was higher( P < 0. 05),the APACHE II score improved more( P <0. 05),and MODS incidence was lower than those in control group( P < 0. 05),but two groups' stay time in ICU showed no statistical difference( P > 0. 05). Conclusions: Therapy with low doses of glucocorticoid can reduce serum CRP and PCT levels of sepsis patients,reverse shock state earlier,improve APACHE II score and reduce incidence of MDOS,but it shows no advantage in reducing treatment time.

关键词(KeyWords)： 糖皮质激素;脓毒症;C-反应蛋白;前降钙素原
glucocorticoid;sepsis;C-reactive protein;procalcitonin

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 方丽,管亚慧,林凤,李春棠,唐忠平
FANG Li,GUAN Yahui,LIN Feng,LI Chuntang,TANG Zhongping

DOI: 10.19367/j.cnki.1000-2707.2015.02.019

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