Huang Guofeng, Liang Bowei, Liu Guojun, Liu Kuisheng, Ding Zhenqi
Center for Orthopedics and Burns, 175th Hospital of People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, PR China, 363000.
Center for Orthopedics and Burns, 175th Hospital of People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, PR China, 363000.
J Crit Care. 2015 Apr;30(2):436.e7-11. doi: 10.1016/j.jcrc.2014.09.016. Epub 2014 Sep 22.
Excessive systemic inflammatory response remains as a major problem underlying severe burns. This study aimed to assess the effect of low-dose glucocorticoid treatment in downregulating systemic inflammation in severely burned patients.
A prospective study from 2001 to 2014 at our hospital was conducted to compare the patients who received low-dose glucocorticoid during the acute phase with those who did not. Patients with burns 70% or greater of their total body surface area were included, and their plasma levels of inflammatory cytokines and clinical outcomes were compared.
A total of 69 patients were included in this study, with 31 patients receiving glucocorticoid treatment and the others not. Patient demographics including age, burn size, and incidence of inhalation injury were similar in both groups. The incidence of pulmonary infection and stress ulcer (and/or hemorrhage) was 24.2% and 3.0% in the treatment group, respectively, significantly lower than 47.8% and 19.6% of the control group (P < .05). Length of hospital stay was almost 13 days shorter in the treatment group (P < .05), whereas there was no significant difference in the overall mortality, duration of mechanical ventilation, and incidence of sepsis between the 2 groups. The enzyme-linked immunosorbent assay results confirmed that the plasma levels of C-reactive protein, tumor necrosis factor-α, interleukin-6, and interleukin-8 were significantly lower in the treatment group (P < .05).
Low dose of glucocorticoid treatment during the acute phase could reduce the levels of proinflammatory cytokines in severely burned patients and subsequently decrease the incidence of pulmonary infection and stress ulcer, as well as the length of hospital stay.
过度的全身炎症反应仍然是严重烧伤的一个主要潜在问题。本研究旨在评估低剂量糖皮质激素治疗对下调严重烧伤患者全身炎症的影响。
2001年至2014年在我院进行了一项前瞻性研究，比较急性期接受低剂量糖皮质激素治疗的患者与未接受治疗的患者。纳入全身表面积烧伤70%或以上的患者，比较他们的炎症细胞因子血浆水平和临床结果。
本研究共纳入69例患者，其中31例接受糖皮质激素治疗，其余未接受。两组患者的人口统计学特征，包括年龄、烧伤面积和吸入性损伤发生率相似。治疗组肺部感染和应激性溃疡（和/或出血）的发生率分别为24.2%和3.0%，显著低于对照组的47.8%和19.6%（P < 0.05）。治疗组的住院时间缩短了近13天（P < 0.05），而两组之间的总死亡率、机械通气时间和脓毒症发生率无显著差异。酶联免疫吸附测定结果证实，治疗组血浆中C反应蛋白、肿瘤坏死因子-α、白细胞介素-6和白细胞介素-8水平显著降低（P < 0.05）。
急性期低剂量糖皮质激素治疗可降低严重烧伤患者促炎细胞因子水平，进而降低肺部感染和应激性溃疡的发生率以及住院时间。
