Williamson David R, Lapointe Marc
Pharmacy Faculty, University of Montreal, Department of Pharmacy Services, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
Pharmacotherapy. 2003 Apr;23(4):514-25. doi: 10.1592/phco.23.4.514.32123.
Severe sepsis is the leading cause of death among patients in intensive care units. Recombinant activated protein C is the only substance known to directly improve morbidity and mortality. Adrenal insufficiency occurs frequently in patients with sepsis and is associated with poor outcome. Although high-dose glucocorticoids have not positively affected clinical outcome, small trials in which low-dose glucocorticoids were administered to patients with septic shock and relative adrenal insufficiency have shown decreased mortality. The main effect of glucocorticoids in low-doses apparently is exerted through correction of suppression of the hypothalamic-pituitary-adrenal axis. However, the therapeutic benefits of glucocorticoids may be related to their antiinflammatory properties and endogenous catecholamine-enhancing effects.
严重脓毒症是重症监护病房患者死亡的主要原因。重组活化蛋白C是已知唯一能直接改善发病率和死亡率的物质。脓毒症患者经常出现肾上腺功能不全，且与不良预后相关。尽管大剂量糖皮质激素对临床结局没有积极影响，但对脓毒性休克和相对肾上腺功能不全患者给予小剂量糖皮质激素的小型试验显示死亡率有所降低。低剂量糖皮质激素的主要作用显然是通过纠正下丘脑-垂体-肾上腺轴的抑制来发挥的。然而，糖皮质激素的治疗益处可能与其抗炎特性和增强内源性儿茶酚胺的作用有关。
