Confalonieri Marco, Trevisan Roberto
Recenti Prog Med. 2006 Jan;97(1):32-6.
Despite advances in antimicrobial therapy and supportive measures, mortality for patients with severe community-acquired pneumonia admitted to the intensive care unit remains high, especially in case of development of sepsis with its complications. So, the early detection of the severity of pneumonia is crucial to achieve an optimal monitoring and treatment of the patients. Studies of serum and lung cytokines levels in patients with pneumonia show a compartimentalized response, that rarely appears in the serum. In case of severe community-acquired pneumonia inflammation spill over from the lungs, particularly there is a persistent increase of IL-6 and CRP in serum, and this is associated with a worst prognosis and possible development of sepsis-related complications. Hydrocortisone and other glucorticoid agents have a powerful modulating effect on inflammation and balance between pro- and anti-inflammatory factors. Recent randomized controlled clinical trials on patients with severe community acquired pneumonia support the use of prolonged infusion of low doses of hydrocortisone to accelerate the resolution of the pneumonia and prevent the development of complications due to sepsis. Moreover, this therapeutic approach seems to be associated with a significant reduction in duration of mechanical ventilation, in length of hospital stay and mortality in hospital.
尽管抗菌治疗和支持措施取得了进展，但入住重症监护病房的重症社区获得性肺炎患者的死亡率仍然很高，尤其是在发生脓毒症及其并发症的情况下。因此，早期检测肺炎的严重程度对于实现对患者的最佳监测和治疗至关重要。对肺炎患者血清和肺细胞因子水平的研究显示出一种分区反应，这种反应很少出现在血清中。在重症社区获得性肺炎的情况下，炎症从肺部溢出，特别是血清中白细胞介素-6和C反应蛋白持续升高，这与预后较差以及脓毒症相关并发症的可能发生有关。氢化可的松和其他糖皮质激素制剂对炎症以及促炎和抗炎因子之间的平衡具有强大的调节作用。最近针对重症社区获得性肺炎患者的随机对照临床试验支持使用低剂量氢化可的松长时间输注，以加速肺炎的消退并预防脓毒症引起的并发症的发生。此外，这种治疗方法似乎与机械通气时间、住院时间和住院死亡率的显著降低有关。
