目的 探討小劑量甲潑尼龍治療嚴(yán)重膿毒癥的臨床療效。方法 選取佛山市第五人民醫(yī)院、伽師縣人民醫(yī)院2013年4月—2015年4月收治的88名符合嚴(yán)重膿毒癥診斷標(biāo)準(zhǔn)的患者,將所有患者隨機(jī)分為對(duì)照組(40例)和治療組(48例)。對(duì)照組給予常規(guī)綜合治療,治療組在常規(guī)綜合治療基礎(chǔ)上給予小劑量甲潑尼龍治療,入院第一天靜脈推注注射用甲潑尼龍琥珀酸鈉120 mg/d,分3次給藥,3 d后根據(jù)病情逐漸減量,連續(xù)治療7 d。觀察兩組患者鈣素原(PCT)、乳酸水平變化,比較急性生理功能和慢性健康(APACHE II)評(píng)分、應(yīng)用血管活性藥時(shí)間、住ICU時(shí)間、并發(fā)癥發(fā)生率和28 d死亡率。結(jié)果 兩組患者在治療后第1、3、5、7天PCT、乳酸水平均較治療前下降,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療組下降的幅度較對(duì)照組大,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后治療組在APACHE II評(píng)分、應(yīng)用血管活性藥時(shí)間、住ICU時(shí)間均較對(duì)照組低,差異具有統(tǒng)計(jì)學(xué)意義(P<0.01)。治療組并發(fā)癥發(fā)生率略高,但與對(duì)照組比較差異無統(tǒng)計(jì)學(xué)意義。兩組患者28 d死亡率相近,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 小劑量注射用甲潑尼龍琥珀酸鈉對(duì)嚴(yán)重膿毒癥患者臨床療效較好,縮短了治療療程,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of small dosage of methylprednisolone in treatment of patients with severe sepsis. Methods Patients (88 cases) with severe sepsis in the 5th People's Hospital of Foshan City and People's Hospital of Jiashi County from April 2013 to April 2015 were randomly divided into control (40 cases) and treatment (48 cases) groups. Patients in control group were given conventional treatment. Patients in treatment group were treated with small dosage of methylprednisolone on the basis of the control group. Methylprednisolone sodium succinate for injection was iv administered 120 mg/d in the first day, 3 times to give medicine, according to the gradual reduction of the disease after 3 d. The patients in two groups were treated for 7 d. Level changes of procalcitonin and lactic acid in two groups were observed, and acute physiology and chronic health function (APACHE II) score, application time of vasoactive drugs, ICU stay time, incidence of complications, and mortality rate in 28 d were compared. Results After treatment of 1, 3, 5, and 7 d, Level of procalcitonin and lactic acid in two groups were significantly decreased, and the difference was statistically significant in the same group (P< 0.05). After treatment, APACHE II score, application time of vasoactive drugs, and ICU stay time in the treatment group were lower than those of the control group, with significant difference between two groups (P< 0.01). The incidence of complications of the treatment group was slightly higher than that of the control group, and mortality rate in 28 d in two groups were equal, but the difference was not statistically significant. Conclusion Small dosage of Methylprednisolone sodium succinate for injection has good clinical efficacy in treatment of patients with severe sepsis, and shortens period of treatment, which has a certain clinical application value.