氢化可的松不同治疗方案对脓毒性休克患者的影响
投稿时间:2016-04-30  修订日期:2016-05-21  点此下载全文
引用本文:濮娜,吴莹,张彩萍.氢化可的松不同治疗方案对脓毒性休克患者的影响[J].医学研究杂志,2017,46(1):164-166
DOI: 10.11969/j.issn.1673-548X.2017.01.043
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作者单位
濮娜 116000 大连大学附属新华医院ICU科 
吴莹 116000 大连大学附属新华医院ICU科 
张彩萍 116000 大连大学附属新华医院ICU科 
中文摘要:目的 探讨氢化可的松不同治疗方案对脓毒性休克患者的影响。方法 选取2014年6月~2015年6月于笔者医院重症医学科进行治疗的80例脓毒性休克患者,随机分为对照组和观察组,各40例。所有患者给予常规治疗,在此基础上,对照组单次缓慢静脉滴注氢化可的松,观察组持续静脉微量泵入氢化可的松。比较两组患者治疗前及治疗6、24、48h及5天时的血流动力学及动脉血乳酸变化,监测两组患者动态血糖,统计高血糖时间窗,比较两组患者预后情况。结果 在各时间点,观察组患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、及乳酸清除率(LCR)与对照组比较,差异均无统计学意义(P>0.05);观察组患者平均血糖水平(MBG)与对照组比较,差异无统计学意义(P>0.05),而最大血糖波动幅度(LAGE)、血糖波动系数(GV)及高血糖时间窗均明显低于对照组,差异具有统计学意义(P<0.05);观察组患者休克持续时间、ICU住院时间、总住院时间及28天病死率与对照组比较,差异均无统计学意义(P>0.05)。结论 较单次缓慢静脉滴注氢化可的松,持续静脉微量泵入氢化可的松更能够稳定脓毒性休克患者血糖波动,有利于平衡机体代谢,而在稳定血流动力学、改善患者预后等方面并没有显著优势。
中文关键词:氢化可的松  脓毒性休克  血流动力学  血糖  预后
 
Effect of Different Regimens of Hydrocortisone on Patients with Septic Shock
Abstract:Objective To investigate the hydrocortisone treatment scheme of septic shock patients. Methods A total of 2014 June 2015 June in our hospital of intensive medicine for treatment of 80 cases of septic shock patients were randomly divided into control group and observation group,with each 40 cases. All patients were given conventional treatment, based on the control group a single slow intravenous drip of hydrocortisone, the observation group of continuous intravenous pumping of hydrocortisone.We compared two groups of patients before treatment and treatment of 6, 24, 48h and 5d of hemodynamics and arterial blood lactate changes.We monitored the two groups of patients with blood Sugar,Calculated the time window of statistical high blood glucose and compared prognosis between the two groups of patients. Results At each time point,heart rate (HR), mean arterial pressure (map), central venous pressure (CVP) and lactate clearance rate (LCR) of patients in the observation group compared with the control group had no statistically significant difference (P>0.05).As for the observation group patients with average blood glucose level (MBG),compared to the control group, the difference was not statistically significant (P>0.05). Maximum blood glucose fluctuation (lage), blood glucose fluctuation coefficient (GV) and high blood sugar time window were significantly lower than control group, and the difference had statistical significance (P<0.05). As for the patients in the observation group, duration of shock, ICU length of stay, hospitalization time and 28 day mortality rate compared with the control group, the difference was not statistically significant (P>0.05). Conclusion Compared with single intravenous drip of hydrocortisone, continuous venous micro pump into hydrocortisone is more capable of stablizing blood glucose fluctuation, is conducive to the metabolic balance, but in hemodynamically stablization, improving prognosis of patients, there were no significant advantages.
keywords:Hydrocortisone  Septic shock  Hemodynamics  Blood glucose  Prognosis
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