摘要
目的临床观察小剂量甲基泼尼龙注射液对严重创伤患者血管外肺水(EVLW)的影响,以评价甲泼尼松龙注射液对严重创伤的治疗作用。方法根据创伤严重程度评分(ISS)选取38例严重创伤患者,随机分成甲泼尼龙治疗组(n=20)和对照组(n=18),均接PICCO监护仪测得治疗前、治疗后第1、3、5天EVLWI,并同步监测氧合指数(PaO2/FIO2)和免疫指标HLA-DR,对两组所得数据进行统计学分析。结果①EVLWI:对照组在3天时EVLWI升高,5天开始下降,而甲泼尼龙治疗组EVLWI 3天后开始下降,5天时降至正常,差异有统计学意义(P<0.05);甲泼尼龙治疗组在治疗后3、5天,EVLWI有明显下降(P<0.05)。②氧合指数:甲泼尼龙治疗组第3天时氧合指数正常,较治疗前有明显升高(P<0.01),对照组氧合指数在5天升至正常,两组比较差异有统计学意义(P<0.05)。③HLA-DR:两组差异无统计学意义(P>0.05)。结论甲泼尼龙注射液通过抑制全身炎性反应,能降低严重创伤患者的血管外肺水指数,改善患者的氧合,同时HLA-DR未下降,提示甲泼尼龙能改善严重创伤后肺损伤,同时对患者免疫功能影响较小。
Objective To observe the effects on severe traumatic extravascular lung edema, and assess the curative effect of Methylpred- nisolone. Methods According to the injury severity score （ISS） 38 severe traumatic patients were selected, randomly divided into Methyipred- nisolone group（n=20） and control group（n=18）. The EVLWI was measured at ldays, 3 days, 5 days monitored by PICCO, the PaO2/FiO2 and HLA-DR also been analyzed. Results EVLWI in the control group reached its peak after 3 days, then gradually declined, however EVLWI in Methylpred- nisolone group declined after 3 days, returned to normal after 5 days, there was significant difference（P〈0.05）. PaO2/FiO2 in Methylprednisolone group got normal at 3 days, which was significant improved than that before therapy, PaO：,/FiO2 in control group returned to normal after 5 days, there were significant difference between the two groups （P〈O,05）. There were no significant difference in HLA-DR between the two groups （P〉0.05）. Conclu- sion Methylprednisolone injection can inhibit inflammatory factors, decline the severe traumatic extravaseular lung edema, improve PaO2/FiO2, therefore it can reduce severe traumatic acute lung injury and do not effect immunological function.
出处
《浙江创伤外科》
2014年第3期359-361,共3页
Zhejiang Journal of Traumatic Surgery
基金
丽水市科技局课题(2012JYZB81)
关键词
甲泼尼龙注射液
严重创伤
血管外肺水
ARDS
Methylprednisolone injection
Severe traumatic
Extravascular lung water
ARDS
