老年脓毒症休克伴免疫抑制病人早期使用小剂量糖皮质激素对预后的影响

doi:10.3969/j.issn.1003-9198.2025.04.012

实用老年医学 ›› 2025, Vol. 39 ›› Issue (4): 382-386.doi: 10.3969/j.issn.1003-9198.2025.04.012

老年脓毒症休克伴免疫抑制病人早期使用小剂量糖皮质激素对预后的影响

郑慧萍, 刘颖, 王念慈, 徐优, 王晨靖, 柳叙, 李炳辰

210006 江苏省南京市, 南京医科大学附属南京医院(南京市第一医院)药学部(郑慧萍, 王晨靖); 重症医学科(刘颖, 徐优, 柳叙, 李炳辰); 急诊医学科(王念慈)

收稿日期:2024-06-26 出版日期:2025-04-20 发布日期:2025-04-22
通讯作者: 王晨靖,Email:385781883@qq.com
基金资助:
南京市医学科技发展项目(YKK21141)

Effects of early use of low-dose glucocorticoids on the prognosis of elderly patients with sepsis shock combined with immunosuppression

ZHENG Huiping, LIU Ying, WANG Nianci, XU You, WANG Chenjing, LIU Xu, LI Bingchen

Department of Pharmacy(ZHENG Huiping, WANG Chenjing); Department of Critical Care Medicine(LIU Ying, XU You, LIU Xu, LI Bingchen); Department of Emergency Medicine(WANG Nianci), Affiliated Nanjing Hospital of Nanjing Medical University(Nanjing First Hospital), Nanjing 210006, China

Received:2024-06-26 Online:2025-04-20 Published:2025-04-22
Contact: WANG Chenjing,Email:385781883@qq.com

摘要/Abstract

摘要： 目的探讨老年脓毒症休克伴免疫抑制病人使用小剂量糖皮质激素对其预后的影响。方法收集2020年10月至2023年12月南京市第一医院ICU、急诊重症医学科(EICU)收治的54例老年脓毒症休克伴免疫抑制病人。根据入ICU 24 h内是否使用小剂量糖皮质激素治疗分为脓毒症激素组(n=26)和脓毒症非激素组(n=28),比较2组临床疗效及安全性。结果脓毒症激素组在激素治疗24 h后,氧合指数及血管药物评分变化(ΔVIS)显著高于脓毒症非激素组(P<0.05)。2组中位生存时间、医院感染发生率、机械通气时间、住ICU时间与住院时间差异没有统计学意义(P>0.05),2组间入ICU第1天及第5天IL-6、IL-10、Treg细胞、CD4、CD56水平差异也没有统计学意义(P>0.05)。脓毒症激素组入ICU第5天的DCreg细胞与CD8水平显著高于脓毒症非激素组(P<0.05)。结论老年脓毒症休克伴免疫抑制病人早期使用小剂量糖皮质激素可改善其氧合功能,减少血管活性药物用量,并不增加医院感染的发生,且不延长住院时间。

关键词: 糖皮质激素, 脓毒症休克, 免疫抑制, 预后

Abstract: Objective To explore the effects of low-dose glucocorticoids on the prognosis of the elderly patients with septic shock combined with immunosuppression. Methods A total of 54 elderly patients with sepsis shock combined with immunosuppression admitted to Intensive Care Unit (ICU) and Emergency Intensive Care Unit (EICU) of Nanjing First Hospital from October 2020 to December 2023 were enrolled in this study. The patients were divided into glucocorticoids group (n=26) and non-glucocorticoids group (n=28) based on whether low-dose glucocorticoid treatment was used.The efficacy and treatment safety were analyzed and compared between the two groups. Results After 24 hours of hormone therapy, the oxygenation index and the change of vasoactive drug score (ΔVIS) in glucocorticoids group were significantly higher than those in non-glucocorticoids group (P<0.05). There were no statistically significant differences in median survival time, incidence rate of hospital infections, duration of mechanical ventilation, ICU and hospital stay between the two groups (P>0.05). The levels of interleukin (IL)-6, IL-10, Treg cell, CD4, and CD56 showed no significant differences between the two groups on the first and fifth day of ICU admission (all P>0.05). On the 5th day of admission at ICU, the levels of DCreg cell and CD8 in glucocorticoids group were significantly higher than those in non-glucocorticoids group (P<0.05). Conclusions Early use of low-dose glucocorticoids in the elderly patients with sepsis shock and immunosuppression can improve the oxygenation function and reduce the dosage of vasoactive drugs, without increasing the incidence of hospital infections and hospitalization stay.

Key words: glucocorticoids, sepsis shock, immunosuppression, prognosis

中图分类号:

R 631.2

郑慧萍, 刘颖, 王念慈, 徐优, 王晨靖, 柳叙, 李炳辰. 老年脓毒症休克伴免疫抑制病人早期使用小剂量糖皮质激素对预后的影响[J]. 实用老年医学, 2025, 39(4): 382-386.

ZHENG Huiping, LIU Ying, WANG Nianci, XU You, WANG Chenjing, LIU Xu, LI Bingchen. Effects of early use of low-dose glucocorticoids on the prognosis of elderly patients with sepsis shock combined with immunosuppression[J]. Practical Geriatrics, 2025, 39(4): 382-386.

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老年脓毒症休克伴免疫抑制病人早期使用小剂量糖皮质激素对预后的影响

Effects of early use of low-dose glucocorticoids on the prognosis of elderly patients with sepsis shock combined with immunosuppression

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