Ng Pak C, Lee Cheuk H, Bnur Flora Liu, Chan Iris H S, Lee Anthony W Y, Wong Eric, Chan Hin B, Lam Christopher W K, Lee Benjamin S C, Fok Tai F
Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Pediatrics. 2006 Feb;117(2):367-75. doi: 10.1542/peds.2005-0869.
To assess the effectiveness of a "stress dose" of hydrocortisone for rescue treatment of refractory hypotension and adrenocortical insufficiency of prematurity in very low birth weight (VLBW) infants. We hypothesized that significantly more VLBW infants who were receiving dopamine > or =10 microg/kg per min could wean off vasopressor support 72 hours after treatment with hydrocortisone.
A double-blind, randomized, controlled study was conducted in a university neonatal center. Forty-eight VLBW infants who had refractory hypotension and required dopamine > or =10 microg/kg per min were randomly assigned to receive a stress dose of hydrocortisone (1 mg/kg every 8 hours for 5 days; n = 24) or an equivalent volume of the placebo solution (isotonic saline; n = 24).
The baseline clinical characteristics were similar between the groups. Serum cortisol concentrations were very low immediately before randomization in both groups of infants. Significantly more VLBW infants who were treated with hydrocortisone weaned off vasopressor support 72 hours after starting treatment. The use of volume expander, cumulative dose of dopamine, and dobutamine were significantly less in hydrocortisone-treated infants compared with control infants. In addition, the median duration of vasopressor treatment was halved in hydrocortisone-treated patients. Two versus 11 infants in the hydrocortisone and control groups required a second vasopressor for treatment of refractory hypotension. The trend (linear and quadratic) of the mean arterial blood pressure was also significantly and consistently higher in hydrocortisone-treated infants.
A stress dose of hydrocortisone was effective in treating refractory hypotension in VLBW infants. Although routine and prophylactic use of systemic corticosteroids could not be recommended because of their potential adverse effects, this relatively low dose of hydrocortisone would probably be preferable to high-dose dexamethasone for treatment of refractory hypotension in emergency and life-threatening situations.
评估氢化可的松“应激剂量”用于抢救治疗极低出生体重（VLBW）早产儿难治性低血压和肾上腺皮质功能不全的有效性。我们假设，接受多巴胺≥10微克/千克每分钟的VLBW婴儿在接受氢化可的松治疗72小时后，能显著更多地停用血管升压药支持。
在一所大学新生儿中心进行了一项双盲、随机、对照研究。48例患有难治性低血压且需要多巴胺≥10微克/千克每分钟的VLBW婴儿被随机分配接受氢化可的松应激剂量（每8小时1毫克/千克，共5天；n = 24）或等量的安慰剂溶液（等渗盐水；n = 24）。
两组的基线临床特征相似。两组婴儿在随机分组前血清皮质醇浓度都非常低。接受氢化可的松治疗的VLBW婴儿在开始治疗72小时后显著更多地停用了血管升压药支持。与对照组婴儿相比，接受氢化可的松治疗的婴儿使用扩容剂的情况、多巴胺和多巴酚丁胺的累积剂量显著更少。此外，接受氢化可的松治疗的患者血管升压药治疗的中位持续时间减半。氢化可的松组和对照组分别有2例和11例婴儿需要第二种血管升压药来治疗难治性低血压。接受氢化可的松治疗的婴儿平均动脉血压的趋势（线性和二次曲线）也显著且持续更高。
氢化可的松应激剂量对治疗VLBW婴儿难治性低血压有效。尽管由于全身用皮质类固醇有潜在不良反应，不建议常规和预防性使用，但在紧急和危及生命的情况下，这种相对低剂量的氢化可的松可能比高剂量地塞米松更适合治疗难治性低血压。
