目的 探讨小剂量甲泼尼龙治疗严重脓毒症的临床疗效。方法 选取佛山市第五人民医院、伽师县人民医院2013年4月—2015年4月收治的88名符合严重脓毒症诊断标准的患者,将所有患者随机分为对照组(40例)和治疗组(48例)。对照组给予常规综合治疗,治疗组在常规综合治疗基础上给予小剂量甲泼尼龙治疗,入院第一天静脉推注注射用甲泼尼龙琥珀酸钠120 mg/d,分3次给药,3 d后根据病情逐渐减量,连续治疗7 d。观察两组患者钙素原(PCT)、乳酸水平变化,比较急性生理功能和慢性健康(APACHE II)评分、应用血管活性药时间、住ICU时间、并发症发生率和28 d死亡率。结果 两组患者在治疗后第1、3、5、7天PCT、乳酸水平均较治疗前下降,差异具有统计学意义(P<0.05)。治疗组下降的幅度较对照组大,差异具有统计学意义(P<0.05)。治疗后治疗组在APACHE II评分、应用血管活性药时间、住ICU时间均较对照组低,差异具有统计学意义(P<0.01)。治疗组并发症发生率略高,但与对照组比较差异无统计学意义。两组患者28 d死亡率相近,差异无统计学意义。结论 小剂量注射用甲泼尼龙琥珀酸钠对严重脓毒症患者临床疗效较好,缩短了治疗疗程,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of small dosage of methylprednisolone in treatment of patients with severe sepsis. Methods Patients (88 cases) with severe sepsis in the 5th People's Hospital of Foshan City and People's Hospital of Jiashi County from April 2013 to April 2015 were randomly divided into control (40 cases) and treatment (48 cases) groups. Patients in control group were given conventional treatment. Patients in treatment group were treated with small dosage of methylprednisolone on the basis of the control group. Methylprednisolone sodium succinate for injection was iv administered 120 mg/d in the first day, 3 times to give medicine, according to the gradual reduction of the disease after 3 d. The patients in two groups were treated for 7 d. Level changes of procalcitonin and lactic acid in two groups were observed, and acute physiology and chronic health function (APACHE II) score, application time of vasoactive drugs, ICU stay time, incidence of complications, and mortality rate in 28 d were compared. Results After treatment of 1, 3, 5, and 7 d, Level of procalcitonin and lactic acid in two groups were significantly decreased, and the difference was statistically significant in the same group (P< 0.05). After treatment, APACHE II score, application time of vasoactive drugs, and ICU stay time in the treatment group were lower than those of the control group, with significant difference between two groups (P< 0.01). The incidence of complications of the treatment group was slightly higher than that of the control group, and mortality rate in 28 d in two groups were equal, but the difference was not statistically significant. Conclusion Small dosage of Methylprednisolone sodium succinate for injection has good clinical efficacy in treatment of patients with severe sepsis, and shortens period of treatment, which has a certain clinical application value.