Service de Réanimation médicale, CHU Habib Bourguiba, Sfax, Tunisie.
Am J Ther. 2013 Nov-Dec;20(6):630-7. doi: 10.1097/MJT.0b013e318269123e.
The purpose of this study was to analyze the efficacy of corticosteroids in severe acute decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation and intensive care unit (ICU) admission. Pairwise retrospective case-control study with 1:1 matching. Patients were defined as cases when they received corticosteroids and as controls when they did not received any steroids. Patients were matched according to age, severity factors at admission represented by the PaO2/FiO2 ratio, and simplified acute physiology score. Thirty-four patients were included. There were 17 patients in the case group and 17 patients in the control group. There were 27 men (80%) and 7 women (20%). The mean age (±SD) was 70 ± 9 years with a range of 40-85 years. Thirty-two patients (94 %) were older than 60 years. The comparison between the 2 groups showed that they had the same epidemiological, clinical, and biological findings on ICU admission. Homodynamic parameters were also not significantly different between the 2 groups. Moreover, there is the same proportion of invasive mechanical ventilation use in 2 groups. Concomitant drugs used were also not significantly different between the 2 groups. Finally, the comparison of outcome between the steroid and steroid-free groups showed that mortality rate was not significantly different (64% vs. 58%, P = 0.72). However, systemic corticosteroid therapy was associated with a significant increase in a reduction in the duration of mechanical ventilation (P = 0.004) and a trend toward a shorter length of ICU stay (P = 0.053). Although the authors detected no significant difference in mortality rate at the time of discharge between steroid and streroid-free patients, this study confirms that systemic corticosteroid therapy in patients with chronic obstructive pulmonary disease exacerbations requiring mechanical ventilation is associated with a significant reduction in the duration of mechanical ventilation. Other studies are needed on this subject.
本研究旨在分析机械通气和重症监护病房（ICU）入院治疗的慢性阻塞性肺疾病（COPD）急性加重患者中皮质类固醇的疗效。这是一项回顾性病例对照研究，采用 1:1 配对。如果患者接受皮质类固醇治疗，则将其定义为病例组，如果未接受任何皮质类固醇治疗，则将其定义为对照组。患者根据年龄、入院时以 PaO2/FiO2 比值表示的严重程度因素和简化急性生理学评分进行配对。共纳入 34 例患者，其中病例组 17 例，对照组 17 例。27 例为男性（80%），7 例为女性（20%）。平均年龄（±SD）为 70±9 岁，范围为 40-85 岁。32 例患者（94%）年龄大于 60 岁。两组比较显示，两组患者在 ICU 入院时的流行病学、临床和生物学特征相同。两组间血流动力学参数也无显著差异。此外，两组有创机械通气使用率相同。两组间同时使用的药物也无显著差异。最后，比较激素组和无激素组的转归，死亡率无显著差异（64%vs.58%，P=0.72）。然而，皮质类固醇治疗与机械通气时间缩短显著相关（P=0.004），且 ICU 住院时间有缩短趋势（P=0.053）。尽管作者未发现出院时激素组和无激素组死亡率有显著差异，但本研究证实，机械通气治疗的 COPD 急性加重患者使用全身皮质类固醇治疗与机械通气时间显著缩短相关。需要进一步开展这方面的研究。
