人类脓毒症急性呼吸窘迫综合征中的肺泡-毛细血管通透性。大剂量皮质类固醇疗法的效果。

Alveolo-capillary permeability in human septic ARDS. Effect of high-dose corticosteroid therapy.

作者信息

Sibbald W J, Anderson R R, Reid B, Holliday R L, Driedger A A

出版信息

Chest. 1981 Feb;79(2):133-42. doi: 10.1378/chest.79.2.133.

DOI:10.1378/chest.79.2.133

Abstract

High-dose corticosteroid therapy has been advocated as adjunctive therapy in the adult respiratory distress syndrome (ARDS). We evaluated the effect of pharmacologic doses of corticosteroid (methylprednisolone and dexamethasone) on alveolo-capillary permeability in human septic ARDS by examining the change in appearance of intravenously administered iodine 131 (131I) human serum albumin (I-HSA) into broncho-alveolar secretions, before and after corticosteroid administration. Of 19 patients examined, in 14 (group 1) the clearance of I-HSA was reduced by corticosteroid (pre, .204 +/- .08 ml;/hr; post, .096 +/- .01 ml/hr; P less than .001), while in five (group 2) it was unaffected (pre, .23 +/- .02 ml/hr; post, .215 +/- .01 ml/hr; P=NS). Group 2 patients were more severely ill than group 1 patients in that their mean intrapulmonary shunt fractions and mean pulmonary artery pressures were higher. We conclude that high-dose corticosteroid therapy may reduce alveolo-capillary permeability in human septic ARDS if used early in the course of the illness.

摘要

大剂量皮质类固醇疗法已被提倡作为成人呼吸窘迫综合征（ARDS）的辅助治疗方法。我们通过检查给予皮质类固醇前后静脉注射碘131（131I）人血清白蛋白（I-HSA）在支气管肺泡分泌物中的外观变化，评估了药理剂量的皮质类固醇（甲泼尼龙和地塞米松）对人类脓毒症性ARDS肺泡-毛细血管通透性的影响。在接受检查的19例患者中，14例（第1组）I-HSA的清除率因皮质类固醇而降低（给药前，0.204±0.08 ml/小时；给药后，0.096±0.01 ml/小时；P<0.001），而5例（第2组）未受影响（给药前，0.23±0.02 ml/小时；给药后，0.215±0.01 ml/小时；P=无显著性差异）。第2组患者比第1组患者病情更严重，因为他们的平均肺内分流分数和平均肺动脉压更高。我们得出结论，如果在疾病过程早期使用，大剂量皮质类固醇疗法可能会降低人类脓毒症性ARDS的肺泡-毛细血管通透性。