Valoor Harsha T, Singhi Sunit, Jayashree M
Department of Pediatrics Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pediatr Crit Care Med. 2009 Jan;10(1):121-5. doi: 10.1097/PCC.0b013e3181936ab3.
To study the efficacy of low-dose intravenous hydrocortisone therapy in the management of pediatric septic shock with respect to the time taken for shock reversal and requirement of inotropes.
Open label randomized pilot study.
Pediatric intensive care unit of a tertiary care pediatric center in a third world country.
Thirty-eight children, 2 months-12 yrs of age, with septic shock unresponsive to fluid therapy alone.
Intravenous hydrocortisone 5 mg/kg/day in four divided doses followed by half the dose for a total duration of 7 days or normal saline (similar amount in a similar manner) for the same duration.
There was a trend toward earlier reversal of shock (median 49.5 vs. 70 hrs, p = 0.65, Mann-Whitney U test) and lower inotropes requirement (median {lsqb;10th-90th centile{rsqb; inotropes score: 20 {lsqb;15-60{rsqb; vs. 50 {lsqb;20-80{rsqb;, p = 0.15) in the hydrocortisone-treated patients as compared with controls, although the difference was not statistically significant. Mortality rate was similar in both groups.
Our data, although, inconclusive favor the need for a study with a larger sample size to clearly define role of low-dose hydrocortisone in pediatric septic shock in developing countries, while taking in consideration effect of malnutrition, delayed presentations, and their interactions with the hypothalamic-pituitary-adrenocortical axis.
研究小剂量静脉注射氢化可的松治疗小儿感染性休克在休克逆转时间和血管活性药物需求方面的疗效。
开放标签随机试验研究。
一个第三世界国家的三级儿科中心的儿科重症监护病房。
38名年龄在2个月至12岁之间、仅接受液体治疗对感染性休克无反应的儿童。
静脉注射氢化可的松5mg/kg/天，分4次给药，随后剂量减半，共持续7天；或给予等剂量等疗程的生理盐水。
与对照组相比，氢化可的松治疗组患者有休克逆转更早的趋势（中位数49.5小时对70小时，p = 0.65，曼-惠特尼U检验）和血管活性药物需求更低（血管活性药物评分中位数[第10-90百分位数]：20[15-60]对50[20-80]，p = 0.15），尽管差异无统计学意义。两组死亡率相似。
尽管我们的数据尚无定论，但支持进行更大样本量的研究，以明确小剂量氢化可的松在发展中国家小儿感染性休克中的作用，同时考虑营养不良、就诊延迟及其与下丘脑-垂体-肾上腺皮质轴的相互作用。
