氢化可的松持续输注与大剂量冲击给药治疗感染性休克的效果：一项前瞻性随机研究

Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study.

作者信息

Salhotra Rashmi, Sharahudeen Ajeeb, Tyagi Asha, Rautela Rajesh S, Kemprai Rajit

机构信息

Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.

出版信息

Indian J Crit Care Med. 2024 Sep;28(9):837-841. doi: 10.5005/jp-journals-10071-24793. Epub 2024 Aug 31.

DOI:10.5005/jp-journals-10071-24793

PMID:39360201

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11443269/

Abstract

AIM AND BACKGROUND

Corticosteroids are recommended for use in adult patients with septic shock requiring vasopressors for blood pressure maintenance. However, this predisposes them to hyperglycemia, which is associated with a poor outcome. This prospective randomized study compares the effect of continuous infusion with bolus hydrocortisone on blood glucose levels in septic shock.

MATERIALS AND METHODS

Forty adult patients with sepsis and septic shock requiring vasopressor support were randomly allocated to either group C (continuous infusion of hydrocortisone 200 mg/day) or group B (intermittent bolus dose of hydrocortisone 50 mg IV 6 hourly). Blood glucose level (primary objective), number of hyperglycemic and hypoglycemic episodes, daily insulin requirement, shock reversal incidence, time to shock reversal, and nursing workload required to maintain blood glucose within the target range (82-180 mg/dL) were compared.

RESULTS

The mean blood glucose level was comparable in the two groups (136.5 ± 22.08 mg/dL in group C vs 135.85 ± 19.06 mg/dL in group B; = 0.921). The number of hyperglycemic and hypoglycemic episodes ( = 1.000 each), insulin requirement/day ( = 1.000), and nursing workload ( = 0.751) were also comparable among groups. Shock reversal was seen in 7/20 (35%) patients in continuous group and 12/20 (60%) patients in bolus group ( = 0.113). Time to shock reversal ( = 0.917) and duration of ICU stay ( = 0.751) were also statistically comparable.

CONCLUSION

Both the regimes of hydrocortisone, continuous infusion, and bolus dose, have comparable effects on blood glucose levels in patients with septic shock.The study was registered prospectively with ctri.nic.in (Ref. No. CTRI/2021/01/030342; registered on 8/1/2021).

HOW TO CITE THIS ARTICLE

Salhotra R, Sharahudeen A, Tyagi A, Rautela RS, Kemprai R. Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study. Indian J Crit Care Med 2024;28(9):837-841.

摘要

目的与背景

对于需要使用血管升压药维持血压的成人感染性休克患者，推荐使用糖皮质激素。然而，这会使他们易发生高血糖，而高血糖与不良预后相关。这项前瞻性随机研究比较了氢化可的松持续输注与大剂量冲击给药对感染性休克患者血糖水平的影响。

材料与方法

40例需要血管升压药支持的成人脓毒症和感染性休克患者被随机分为C组（氢化可的松200mg/天持续输注）或B组（氢化可的松50mg静脉注射，每6小时一次的间歇性大剂量给药）。比较血糖水平（主要指标）、高血糖和低血糖发作次数、每日胰岛素需求量、休克逆转发生率、休克逆转时间以及将血糖维持在目标范围（82 - 180mg/dL）所需的护理工作量。

结果

两组的平均血糖水平相当（C组为136.5±22.08mg/dL，B组为135.85±19.06mg/dL；P = 0.921）。高血糖和低血糖发作次数（每组均为P = 1.000）、每日胰岛素需求量（P = 1.000）以及护理工作量（P = 0.751）在两组间也相当。持续输注组20例患者中有7例（35%）出现休克逆转，大剂量冲击给药组20例患者中有12例（60%）出现休克逆转（P = 0.113）。休克逆转时间（P = 0.917）和重症监护病房住院时间（P = 0.751）在统计学上也具有可比性。