【摘要】 目的探讨早期应用小剂量糖皮质激素对脓毒症休克患者血流动力学及免疫功能的影响。方法选择2013年6月至2016年8月脓毒症休克患者80例,随机分为对照组、早期激素治疗组和晚期激素治疗组,所有入选患者于治疗前、治疗后12 h、24 h、48 h监测MAP、HR及血乳酸水平;采用流式细胞术检测治疗前、治疗后1 d、3 d、7 d外周血CD+4细胞的凋亡率及HLA-DR的表达。结果治疗后12 h、24 h、48 h对照组,早期激素治疗组及晚期激素治疗组患者MAP、HR及血乳酸水平均较治疗前明显改善;各组治疗后比较,早期激素治疗组治疗后24 h、48 h患者MAP、HR均较晚期激素治疗组和对照组明显好转,差异有统计学意义(P<0.05);晚期激素治疗组治疗后24 h MAP较对照组明显升高;早期激素治疗组和晚期激素治疗组治疗后12 h、24 h血乳酸水平均较对照组明显下降,早期激素治疗组血乳酸水平均较晚期激素治疗组明显下降,差异有统计学意义(P<0.05);早期激素治疗组和晚期激素治疗组血管活性药应用时间较对照组明显缩短,差异有统计学意义(P<0.05);早期激素治疗组血管活性药应用时间较晚期激素治疗组明显缩短,差异有统计学意义(P<0.05);治疗后3 d及7 d各组外周血CD+4细胞的凋亡率平均较治疗前明显下降,且随着时间的延长,外周血CD+4细胞的凋亡率明显下降,差异有统计学意义(P<0.05);早期激素治疗组和晚期激素治疗组治疗后3 d、7 d外周血CD+4细胞的凋亡率均较对照组明显下降,差异有统计学意义(P<0.05);早期激素治疗组治疗后3 d、7 d外周血CD+4细胞的凋亡率均较晚期激素治疗组明显下降,差异有统计学意义(P>0.05);治疗后1 d、3 d及7 d各组外周血单核细胞HLA-DR的表达水平均较治疗前明显上升,且随着时间的延长,外周血单核细胞HLA-DR的表达水平逐渐升高,差异有统计学意义(P<0.05);3组治疗后各时间点外周血单核细胞HLA-DR的表达水平均差异无统计学意义(P>0.05)。结论早期应用小剂量糖皮质激素可以更快的恢复脓毒症休克患者的血流动力学,且对免疫功能具有一定的调节作用。更多还原

【Abstract】 Objective To investigate the effects of early low-dose glucocorticoid on hemodynamics and immune function in patients with septic shock. Methods Eighty patients with septic shock who were treated in our hospital from June2013 to August 2016 were randomly devided into control group,early hormone treatment group and late hormone treatment group. The levels of MAP,HR and serum levels of lactate were detected before treatment,at 12 h,24 h,48 h after treatment for all the patients. Moreover the apoptosis rate of CD+4 cells and expression levels of HLA-DR in peripheral blood before treatment and at 1 d. 3 d,7 d after treatment were detected by flow cytometry. Results The serum levels of MAP,HR and lactate at 12 h,24 h,48 h after treatment were obviously improved in the three groups. After treatment the levels of MAP,HR at 24 h,48 h after treatment in early hormone treatment group were significantly improved,as compared with those in late hormone treatment group and control group(P < 0. 05). The levels MAP at 24 h after treatment in late hormone treatment group were significantly higher than those in control group,and the serum levels of lactate at 12 h,24 h after treatment in early hormone treatment group and late hormone treatment group were obviously lower than those in control group,moreover,which in early hormone treatment group were significantly lower than those in late hormone treatment group(P < 0. 05). The application time of vasoactive drug in early hormone treatment group and late hormone treatment group was significantly shorter than that in control group(P <0. 05),moreover,which in early hormone treatment group was significantly shorter than that in late hormone treatment group(P < 0. 05). The apoptosis rate of CD+4 cells at 3 d,7 d after treatment was significantly decreased in the three groups,as compared with that before treatment,moreover,which was more significatly decreased with the time going on(P < 0. 05). The apoptosis rates of CD+4 cells at 3 d,7 d after treatment in early hormone treatment group and late hormone treatment group were significantly lower than those in control group(P < 0. 05),moreover,which in early hormone treatment group were significantly lower than those in late hormone treatment group(P < 0. 05). In addition the expression levels of HLA-DR peripheral blood monouclear cells at 1 d,3 d,7 d after treatment were significantly increased in the three groups,as compared with those before treatment,moreover,which were more significatly increased with the time going on(P < 0. 05). However there were no significant differences in the expression levels of HLA-DR in the three groups except for the three time points(P > 0. 05). Conclusion The application of early low-dose glucocorticoid can more quickly recover hemodynamics of patients with septic shock,moreover,which has a certain regulatory effects on immune function of patients.更多还原