关键词: 脓毒性休克, 皮质醇, 促肾上腺皮质激素, 甲泼尼龙

Abstract:

AIM: To investigate the therapeutic effects of different dosages of methylprednisolone (MP) on the children with septic shock (SS) in decompensation stage, and analyse the changes of hypothalamic-pituitary-adrenal (HPA) axis. METHODS: Eighty-one children with SS in decompensation stage were randomly divided into three groups according to the MP initial dosages: the high-dosage group (20 mg·kg^-1·d^-1), the middle-dosage group (5 mg·kg^-1·d^-1) and the low-dosage group (2 mg·kg^-1·d^-1). The MP dosages were reduced gradually after a week. The therapeutic effects of the three groups were recorded. The serum cortisol, adrenocorticotropic hormone (ACTH) were analyzed on day 1, 3, 8 in hospital and compared with those of 27 healthy controls. RESULTS:The fever clearance time, SS correct time and the time of vasoactive drug used in the middle-dosage group and the high-dosage group were obviously decreased compared with the low-dosage group (P＜0.05). The mortality of the three groups were not statistically significant (P＞0.05). The length of stay in the low-dosage group and the middle-dosage group were statistically shorter than that in the high-dosage group (P＜0.05). The double infect in the high-dosage group was statistically more than that in the middle-dosage group and the low-dosage group (P＜0.05). Large amplitude of glycemic excursions (LAGE) of the high-dosage group and the middle-dosage group were obviously wider than that of the low-dosage group (P＜0.05). At the first day of admission, the three groups with SS in decompensation stage had statistical increase of serum cortisol and ACTH as compared with the healthy control group, but there were not significant differences among the three groups (P＞0.05), the serum cortisol and ACTH in the death children were significantly higher than the survival children in the three groups (P＜0.05). At the third day of admission, serum cortisol and ACTH in the middle-dosage group and the high-dosage group were obviously decreased as compared with those of the low-dosage group (P＜0.05), the serum cortisol and ACTH in the death children were significantly lower than the survival children in the three groups (P＜0.05). At the eighth day of admission, the serum cortisol and ACTH of the three groups were no statistical differences compared with those of the healthy control group (P＞0.05). CONCLUSION: The low-dosage of MP can be used to guide the therapy of children with SS in decompensation stage, which is conductive to control inflammation, shorten the length of stay, and reduce LAGE, decrease serum cortisol and ACTH slowly. High or rapid decreasing serum cortisol and ACTH levels are indicators of mortality risk.

Key words: septic shock, cortisol, adrenocorticotropic hormone, methylprednisolone