脓毒性休克出现后早期给予氢化可的松替代治疗对生存和免疫反应的影响*。
Early administration of hydrocortisone replacement after the advent of septic shock: impact on survival and immune response*.
机构信息
1Intensive Care Unit, Korgialeneion-Benakeion Hospital, Athens, Greece. 22nd Department of Critical Care Medicine, University of Athens, Medical School, Athens, Greece. 3Intensive Care Unit, Ptolemaida General Hospital, Ptolemaida, Greece. 4Intensive Care Unit, Korinthos General Hospital, Korinthos, Greece. 5Department of Internal Medicine, Zakynthos General Hospital, Zakynthos, Greece. 6Intensive Care Unit, Ippokrateion Athens General Hospital, Athens, Greece. 74th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece. 81st Department of Critical Care Medicine, University of Athens, Medical School, Athens, Greece. 9Department of Therapeutics, University of Athens, Medical School, Athens, Greece. 10Intensive Care Unit, "G.Gennimatas" Hospital, Thessaloniki, Greece. 11Department of Infectious Diseases, Patras University Hospital, Rion, Greece.
出版信息
Crit Care Med. 2014 Jul;42(7):1651-7. doi: 10.1097/CCM.0000000000000318.
OBJECTIVES
To investigate the impact of early initiation of hydrocortisone therapy on the clinical course of septic shock and on cytokine release.
DESIGN
Prospective study in patients with septic shock treated with low doses of hydrocortisone.
SETTING
ICUs and general wards.
PATIENTS
Over a 2-year period, 170 patients with septic shock treated with low doses of hydrocortisone were enrolled. Blood was sampled from 34 patients for isolation of peripheral blood mononuclear cells and cytokine stimulation before and 24 hours after the start of hydrocortisone.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
After quartile analysis, patients were divided into those with early initiation of hydrocortisone (< 9 hr after vasopressors, n = 46) and those with late initiation of hydrocortisone (> 9 hr after vasopressors, n = 124). After adjusting for disease severity and type of infection, a protective effect of early hydrocortisone administration against unfavorable outcome was found (hazard ratio, 0.20; p = 0.012). Time of discontinuation of vasopressors was earlier among patients with initiation of hydrocortisone within 9 hours. Production of tumor necrosis factor-α was lower among patients who had had hydrocortisone early.
CONCLUSIONS
In patients receiving hydrocortisone for septic shock, early initiation of treatment was associated with improved survival. This treatment was also associated with attenuated stimulation of tumor necrosis factor-α.
目的
研究早期开始氢化可的松治疗对感染性休克临床病程和细胞因子释放的影响。
设计
对接受低剂量氢化可的松治疗的感染性休克患者进行的前瞻性研究。
地点
重症监护病房和普通病房。
患者
在 2 年期间，纳入了 170 例接受低剂量氢化可的松治疗的感染性休克患者。从 34 例患者中抽取血液，用于分离外周血单个核细胞，并在开始使用氢化可的松前和 24 小时后进行细胞因子刺激。
干预措施
无。
测量和主要结果
经过四分位分析，患者分为早期（血管加压药后 < 9 小时）和晚期（血管加压药后 > 9 小时）开始使用氢化可的松的两组。在调整疾病严重程度和感染类型后，发现早期使用氢化可的松对不良结局有保护作用（危险比，0.20；p = 0.012）。在 9 小时内开始使用氢化可的松的患者中，停用血管加压药的时间更早。早期使用氢化可的松的患者肿瘤坏死因子-α的产生较低。
结论
在接受氢化可的松治疗感染性休克的患者中，早期开始治疗与生存率的提高相关。这种治疗还与肿瘤坏死因子-α刺激的减弱有关。
Zotero 插件