氢化可的松100 mg丸加200 mg/天输注与单独输注治疗难治性感染性休克的比较

Journal of intensive medicine Pub Date : 2025-10-01 DOI:10.1016/j.jointm.2025.02.002

Ukrit Jiradechpitak, Theerapon Tangsuwanaruk, Patipan Sitthiprawiat, Borwon Wittayachamnankul

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引用次数: 0

摘要

背景：目前的指南推荐添加200mg /天的氢化可的松用于治疗对液体和血管加压药物无反应的感染性休克。然而，在这个方案中添加100毫克的益处仍不清楚。该研究评估了200毫克/天的氢化可的松加或不加100毫克丸治疗难治性感染性休克的疗效。方法本回顾性队列研究纳入2019年至2023年在三级保健中心接受治疗的成人难治性感染性休克患者。根据医生的决定，将患者分为丸组（接受100 mg氢化可的松丸，随后连续输注200 mg/天）和非丸组（接受200 mg/天连续输注，不加丸）。主要结局是血管加压药的持续时间和休克逆转。次要结局包括28天死亡率和住院时间。组间比较采用卡方检验、t检验和Kaplan-Meier生存分析。结果共纳入184例患者，其中丸剂组149例，非丸剂组35例。两组抗利尿激素持续时间中位数均为1天（四分位数间距[IQR]: 1 - 2），差异有统计学意义（P=0.967）。注射组和非注射组的休克逆转发生率分别为79.9% %和82.9 % （OR=0.82, 95% CI: 0.30 ~ 2.23， P=0.688）。注射组和非注射组的次要结局，包括28天死亡率（30.2% %对22.9 %，OR=1.46, 95% CI: 0.62 ~ 3.43， P=0.745）和住院时间（9 [IQR: 6-17]天对11 [IQR: 5-15]天，P=0.875），均无显著差异。Kaplan-Meier生存分析显示，两组28天生存率无差异（HR=1.29, 95% CI: 0.73 ~ 2.30， P=0.373）。结论在200mg /d氢化可的松治疗方案的基础上加用100mg丸可能不会影响难治性感染性休克的临床结果。

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Comparison of hydrocortisone 100 mg bolus plus 200 mg/day infusion vs. infusion alone in refractory septic shock

Background

Current guidelines recommend the addition of hydrocortisone 200 mg/day for the treatment of septic shock unresponsive to fluids and vasopressors. However, the benefits of adding a 100 mg bolus to this regimen remain unclear. The study assessed the efficacy of the administration of hydrocortisone 200 mg/day with or without a 100 mg bolus in refractory septic shock.

Methods

This retrospective cohort study included adult patients with refractory septic shock treated at a tertiary care center between 2019 and 2023. Patients were divided into bolus group (receiving a 100 mg hydrocortisone bolus followed by a 200 mg/day continuous infusion) and non-bolus group (receiving a continuous infusion of 200 mg/day without the addition of a bolus) based on physician decision. The primary outcomes were the duration of vasopressor and shock reversal. Secondary outcomes included 28-day mortality and length of hospital stay. Comparisons between groups were performed using chi-squared tests, t-tests, and Kaplan–Meier survival analysis.

Results

A total of 184 patients were included, 149 patients in the bolus group and 35 patients in the non-bolus group. The median vasopressor duration was 1 (interquartile range [IQR]: 1–2) days in both groups (P=0.967). Shock reversal occurred in 79.9 % of the bolus group and 82.9 % of the non-bolus group (OR=0.82, 95% CI: 0.30 to 2.23, P=0.688). Secondary outcomes in the bolus group and non-bolus group, including 28-day mortality (30.2 % vs. 22.9 %, OR=1.46, 95% CI: 0.62 to 3.43, P=0.745) and hospital length of stay (9 [IQR: 6-17] days vs. 11 [IQR: 5-15] days, P=0.875), did not show any significant differences. Kaplan–Meier survival analysis showed no difference in 28-day survival between groups (HR=1.29, 95% CI: 0.73 to 2.30, P=0.373).