甲基强的松龙在需要重症监护住院的2019冠状病毒病(COVID-19)患者中的应用:一项纵向观察研究

IF 0.1 Q4 ANESTHESIOLOGY
L. Doucet, S. Hoflack, L. Van Slambrouck, P. Lormans
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引用次数: 0

摘要

甲基强的松龙在需要重症监护住院治疗的2019冠状病毒病(新冠肺炎)患者中的使用:一项纵向观察研究。背景:长期以来,在2019冠状病毒病(新冠肺炎)危重患者中使用皮质类固醇一直是一种有争议的治疗方法。然而,鉴于这一主题的相互矛盾的证据,我们研究了甲基强的松龙对危重患者的影响,并在这里分享了我们在实验室发现和Pa02/FiO2比率(动脉血气样本的部分氧浓度与吸入氧分数的比率)方面的经验。方法:在68名因新冠肺炎感染而在重症监护室住院的患者中,28名严重呼吸衰竭患者接受了为期12天的固定方案甲基强的松龙治疗(125 mg IV,为期2天,随后2次0.5 mg/kg IV,为期5天,每天两次,然后递减方案,为期4天,直至停药)。在第5天和第10天之后,我们分析了我们的患者的CRP(C反应蛋白)、淋巴细胞增多症、D-二聚体、LDH(乳酸脱氢酶)和PaO2/FiO2比率的水平。结果:我们观察到,在第0天(开始甲基强的松龙治疗)到第5天(p=0.001),以及第0天到第10天(p=0.005),中位CRP水平显著下降。在第5天到第十天之间没有下降(p=0.052)。在第0天至第5天之间(p=0.009)和第0天至第10天之间(p=0.019),在第0天和第10天之间仅发现显著差异(p=0.018)。在治疗开始和第5天或第10天期间,淋巴细胞增多症和LDH水平没有观察到显著差异。结论:在开始甲基强的松龙后,CRP水平显著且持续地显著下降,PaO2/FiO2比率倾斜。D-二聚体的下降速度较慢,但也很显著。需要进一步的研究和对照组分析来证实这种影响是由皮质类固醇治疗引起的。然而,这表明甲基强的松龙可能在治疗需要入住ICU的重症新冠肺炎患者中发挥非常重要的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study
The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study. Background : For a long time, the use of corticosteroids in critically ill patients with coronavirus disease 2019 (COVID-19) has been a controversial treatment. How- ever, given the conflicting evidence on this topic, we studied the effects of methylprednisolone on critically ill patients and - share here our experience on laboratory findings and the Pa02/FiO2 ratio (ratio of partial oxygen concentration on arterial blood gas sample to fraction of inspired oxygen). Methods : In a population of 68 patients hospitalized in the intensive care unit due because of COVID-19 infection, 28 patients with severe respiratory failure received methylprednisolone on a fixed 12-day regimen (125 mg IV for 2 days, followed by 2x0.5 mg/kg IV twice daily for 5 days, and then a decreasing regimen for 4 days until discontinuation). After day 5 and day 10, we analyzed the levels of CRP (C-reactive protein), lymphocytosis, D-dimer, LDH (lactate dehydrogenase) and PaO 2 /FiO 2 ratio of our patients. Results : We observed a significant decrease in median CRP levels between day 0 (start of methylprednisolone treatment) and day 5 (p=0.001), and between day 0 and day 10 (p=0.005). No decrease was seen between day 5 and 10 (p=0.352). The same increase in PaO 2 /FiO 2 was recorded between day 0 and day 5 (p=0.009), and between 0 and day 10 (p=0.019). For D-dimer, only a significant difference was found between day 0 and day 10 (p=0.018). No significant difference could be observed for lymphocytosis and LDH levels between the beginning of the treatment and day 5 or day 10. Conclusion : There is a strong and sustained significant decrease in CRP levels and a tilt in the PaO2/FiO2 ratio after starting methylprednisolone. A slower, but also significant decrease was found for D-dimer. Further research and control group analyses are needed to confirm that this effect is due to corticostreoid treatment. However, this indicates that methylprednisolone may play a very important role in the treatment of the severely ill COVID-19 patients requiring ICU admission.
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来源期刊
CiteScore
0.20
自引率
0.00%
发文量
2
期刊介绍: L’Acta Anaesthesiologica Belgica est le journal de la SBAR, publié 4 fois par an. L’Acta a été publié pour la première fois en 1950. Depuis 1973 l’Acta est publié dans la langue Anglaise, ce qui a été résulté à un rayonnement plus internationaux. Depuis lors l’Acta est devenu un journal à ne pas manquer dans le domaine d’Anesthésie Belge, offrant e.a. les textes du congrès annuel, les Research Meetings, … Vous en trouvez aussi les dates des Research Meetings, du congrès annuel et des autres réunions.
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