早期小剂量激素对泌尿系感染性休克EGDT后急性肺损伤的预防及临床价值

徐时方; 徐建国; 潘娅静; 杨宝华; 李林锦

doi:10.13201/j.issn.1001-1420.2021.12.005

早期小剂量激素对泌尿系感染性休克EGDT后急性肺损伤的预防及临床价值

- 1. 温州市人民医院ICU(浙江温州, 325000);
- 2. 温州市人民医院急诊科;
- 3. 温州市人民医院泌尿外科
基金项目:
温州市科技局基础性医疗卫生科技项目（No：Y20190455）

详细信息

通讯作者: 徐时方,E-mail:282319014@qq.com

中图分类号: R459.1

收稿日期: 2020-12-29

Prophylactic and clinical effects of early low dose hormone on acute lung injury after EGDT for septic shock due to urinary infection

- 1. Department of ICU, Wenzhou People's Hospital, Wenzhou, Zhejiang, 325000, China;
- 2. Department of Emergency, Wenzhou People's Hospital;
- 3. Department of Urology, Wenzhou People's Hospital

More Information

Corresponding author: XU Shifang, E-mail: 282319014@qq.com

Received Date: 29 December 2020

摘要

摘要: 目的：探讨早期小剂量激素对泌尿系感染性休克早期目标导向治疗（early goal directed therapy，EGDT）后急性肺损伤的预防及临床价值。方法：选择2019年1月—2020年10月在院治疗的诊断为泌尿系感染性休克患者84例，按患者入院顺序编号奇偶数法均分为对照组（EGDT及抗感染手术等综合治疗）、治疗组各42例（在抗感染手术等综合治疗+早期小剂量氢化可的松琥珀酸钠200 mg/d微泵持续维持，与EGDT同时开始），对两组患者在年龄、性别、入ICU前的SOFA评分和APACHE-Ⅱ评分、3 h EGDT达标例数、6 h EGDT达例数，入院第1、3、7、10天白细胞计数、降钙素原（PCT）值、C反应蛋白（CRP）值，ICU期间最差氧合指数并统计符合诊断的急性肺损伤发生例数，进展至ARDS呼吸衰竭气管插管例数、ICU 7 d、ICU 14 d转出例数、28 d死亡例数进行比较。结果：两组3 h达标例数、7 d转出例数比较差异有统计学意义（P<0.05）。治疗组在入院第3、7天白细胞值，第3天PCT值，第7天CRP值恢复更快。治疗组中急性肺损伤例数、气管插管例数小于对照组，两组气管插管例数比较差异有统计学意义（P<0.05），两组28 d死亡率比较差异无统计学意义（P>0.05）。结论：早期小剂量激素能促进泌尿系感染性休克患者EGDT更快达标，缩短感染指标的恢复时间，降低EGDT后气管插管的发生，缩短ICU停留时间，减少费用支出，具有一定的临床价值。
- 小剂量激素 /
- 泌尿系感染 /
- 感染性休克 /
- 早期目标导向治疗 /
- 急性肺损伤
Abstract: Objective: To investigate the preventive and clinical value of early low dose hormone on acute lung injury after EGDT for septic shock due to urinary infection.Methods: Between January 2019 and October 2020, 84 cases of septic shock due to urinary infection were chosen. They were equally divided into control group(comprehensive treatment including EGDT and anti-infection surgery) and treatment group(comprehensive treatment including anti-infection surgery+early low-dose hydrocortisone sodium succinate 200 mg/d at the same time with EGDT) according to odd and even numbers of the admission number. Patients' age, gender, SOFA scale and APACHE-Ⅱ score before entering the ICU, 3 hours and 6 hours of the number of cases up to EGDT standard, white blood cell count of 1, 3, 7, 10 days after the admission, value of PCT and CRP value, the worst oxygenation index in ICU, number of acute lung injury cases, number of progression to the ARDS and endotracheal intubation, number of cases of transfer out of ICU on 7 th and 14 th days, death cases on 28 th day were compared between two groups.Results: There was statistically significant difference in the number of patients reaching the target in 3 hours and transfer out of ICU on 7 th day between the two groups(P<0.05). In the treatment group, WBC value on day 3 and 7, PCT value on day 3, and CRP value on day 7 recovered faster. The number of acute lung injury cases and endotracheal intubation cases in the treatment group were smaller than those in the control group, and the number of endotracheal intubation cases was different between the two groups(P<0.05). However, there was no difference in 28-day mortality between the two groups(P>0.05).Conclusion: Early low-dose hormone can promote EGDT in patients with septic shock due to urinary infection to reach the standard faster, shorten the recovery time of infection indicators, reduce the occurrence of respiratory failure after EGDT, shorten ICU stay, and reduce expenses, so it has certain clinical value.
- low dose hormone /
- urinary tract infection /
- septic shock /
- EGDT /
- acute lung injury

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