小劑量糖皮質(zhì)激素治療重癥社區(qū)獲得性肺炎的臨床分析

楊青

【摘要】 目的 探討治療重癥社區(qū)獲得性肺炎過程中應(yīng)用小劑量糖皮質(zhì)激素的臨床療效。方法 90例重癥社區(qū)獲得性肺炎患者， 按治療方法的不同分為激素組（40例）與對(duì)照組（50例）。激素組和對(duì)照組均從入院開始應(yīng)用抗生素、止咳、祛痰、吸氧等綜合治療， 激素組在綜合治療基礎(chǔ)上同時(shí)應(yīng)用小劑量糖皮質(zhì)激素， 且必要時(shí)加用抑酸藥以保護(hù)胃黏膜。比較兩組患者的臨床療效及不良反應(yīng)發(fā)生情況。結(jié)果 激素組總有效率87.5%高于對(duì)照組的70.0%， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后激素組患者體溫恢復(fù)時(shí)間、咳嗽減輕時(shí)間、氣短減輕時(shí)間及肺部啰音消失時(shí)間分別為（3.5±2.4）、（7.4±3.0）、（3.9±2.8）、（9.9±2.3）d均明顯短于對(duì)照組的（5.9±2.3）、（10.1±2.6）、（6.9±2.9）、（11.4±1.9）d， 差異均具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者白細(xì)胞計(jì)數(shù)復(fù)常時(shí)間、C反應(yīng)蛋白及降鈣素原下降時(shí)間、病原菌清除時(shí)間比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組患者肺部影像學(xué)檢查恢復(fù)時(shí)間、住院時(shí)間、不良反應(yīng)及二重感染發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 重癥社區(qū)獲得性肺炎患者應(yīng)用小劑量激素療效顯著， 應(yīng)用糖皮質(zhì)激素可改善重癥社區(qū)獲得性肺炎的臨床癥狀及預(yù)后， 很大程度上減少了患者痛苦， 有效地縮短了治療時(shí)間， 但少數(shù)患者仍有相關(guān)不良反應(yīng)發(fā)生。

【關(guān)鍵詞】 重癥社區(qū)獲得性肺炎；糖皮質(zhì)激素；小劑量

DOI：10.14163/j.cnki.11-5547/r.2018.35.007

【Abstract】 Objective To discuss the clinical efficacy of low-dose glucocorticoids in the treatment of severe community acquired pneumonia. Methods A total of 90 patients with severe community acquired pneumonia were divided by different treatment methods into hormone group （40 cases） and control group （50 cases）. Both the hormone group and the control group all received comprehensive therpay of antibiotics， antitussive， expectorant， and oxygen inhalation from the admission of hospital， and the hormone group received small doses of glucocorticoids on the basis of comprehensive treatment， and if necessary， added acid inhibitors to protect the gastric mucosa. The clinical efficacy and occurrence of adverse reactions between the two groups was compared. Results Hormone group had higher total effective rate as 87.5% than 70.0% in the control group， and the difference was statistically significant （P<0.05）. After treatment， hormone group had obviously shorter body temperature recovery time， cough remission time， shortness of breath symptom remission time and pulmonary rales disappearance time were respectively as （3.5±2.4）， （7.4±3.0）， （3.9±2.8） and （9.9±2.3） d than （5.9±2.3）， （10.1±2.6）， （6.9±2.9） and （11.4±1.9） d in the control group， and their difference was statistically significant （P<0.05）. Both groups had no statistically significant difference in white blood cell recovery time， C-reactive protein and procalcitonin fall time， pathogen clearance time （P>0.05）. Both groups had no statistically significant difference in pulmonary imaging examination recovery time， hospitalization time， incidence of adverse reactions and double infection （P>0.05）. Conclusion Low-dose glucocorticoid shows remarkable efficacy in the treatment of patients with severe community acquired pneumonia， and it can improve the clinical symptoms and prognosis of severe community acquired pneumonia， reduce the pain of patients to a large extent and shorten the treatment time effectively， but a few patients still have related adverse reactions.

【Key words】 Severe community acquired pneumonia； Glucocorticoid； Low dose

社區(qū)獲得性肺炎是呼吸系統(tǒng)疾病中較常見的疾病之一， 其傳染性強(qiáng)， 而且近年來由于我國社會(huì)人口進(jìn)入老齡化、抗生素耐藥率的上升、病原體的變遷以及免疫缺陷宿主的增加等因素影響[1]， 導(dǎo)致其發(fā)病率和死亡率較高， 尤其中重癥社區(qū)獲得性肺炎的病死率更高， 可達(dá)15%～30%， 嚴(yán)重威脅生命安全[2]。因此， 除抗生素外的其他治療方法倍受國內(nèi)外醫(yī)生關(guān)注， 其中糖皮質(zhì)激素的應(yīng)用最受重視， 臨床應(yīng)用也相對(duì)較多， 但仍存在一定的爭議。本……