Allary J, Annane D
Department of Anesthesiology and Critical Care, Raymond Poincaré Hospital, University of Medicine, Paris Ile de France Ouest, Garches, France.
Minerva Anestesiol. 2005 Dec;71(12):759-68.
Although systemic inflammation is the hallmark of sepsis, the use of glucocorticoids remained controversial during many years. Gluco-corticoids exert key actions during sepsis, interacting with metabolism, immune and cardiovascular systems. Glucocorticoid insufficiency is common during sepsis and may result from insufficient production of cortisol or peripheral tissues resistance. Thus, recent randomised trials showed that a replacement therapy with long course of low dose corticosteroids reduced mortality from septic shock. Improvement in survival may result from reduced duration of shock, alleviation of the systemic inflammatory response, and reduction in the number and intensity of organs dysfunction. This article summarises why, when and how glucocorticoids should be used in the management of septic shock.
尽管全身炎症是脓毒症的标志，但多年来糖皮质激素的使用一直存在争议。糖皮质激素在脓毒症期间发挥关键作用，与代谢、免疫和心血管系统相互作用。脓毒症期间糖皮质激素不足很常见，可能是由于皮质醇分泌不足或外周组织抵抗所致。因此，最近的随机试验表明，长期低剂量糖皮质激素替代疗法可降低感染性休克的死亡率。生存率的提高可能源于休克持续时间缩短、全身炎症反应减轻以及器官功能障碍的数量和严重程度降低。本文总结了在感染性休克的治疗中为何、何时以及如何使用糖皮质激素。
