mgl206
健康人生，从心开始
医博园版主
发贴:4172
积分:557得票:21状态:离线2008-01-2118:46HydrocortisoneTherapyforPatientswithSepticShock
ABSTRACT
Background
Hydrocortisoneiswidelyusedinpatientswithsepticshockeventhoughasurvivalbenefithasbeenreportedonlyinpatientswhoremainedhypotensiveafterfluidandvasopressorresuscitationandwhoseplasmacortisollevelsdidnotriseappropriatelyaftertheadministrationofcorticotropin.
Methods
Inthismulticenter,randomized,double-blind,placebo-controlledtrial,weassigned251patientstoreceive50mgofintravenoushydrocortisoneand248patientstoreceiveplaceboevery6hoursfor5days;thedosewasthentaperedduringa6-dayperiod.At28days,theprimaryoutcomewasdeathamongpatientswhodidnothavearesponsetoacorticotropintest.
Results
Ofthe499patientsinthestudy,233（46.7%）didnothavearesponsetocorticotropin（125inthehydrocortisonegroupand108intheplacebogroup）.At28days,therewasnosignificantdifferenceinmortalitybetweenpatientsinthetwostudygroupswhodidnothavearesponsetocorticotropin（39.2%inthehydrocortisonegroupand36.1%intheplacebogroup,P=0.69）orbetweenthosewhohadaresponsetocorticotropin（28.8%inthehydrocortisonegroupand28.7%intheplacebogroup,P=1.00）.At28days,86of251patientsinthehydrocortisonegroup（34.3%）and78of248patientsintheplacebogroup（31.5%）haddied（P=0.51）.Inthehydrocortisonegroup,shockwasreversedmorequicklythanintheplacebogroup.However,thereweremoreepisodesofsuperinfection,includingnewsepsisandsepticshock.
Conclusions
Hydrocortisonedidnotimprovesurvivalorreversalofshockinpatientswithsepticshock,eitheroverallorinpatientswhodidnothavearesponsetocorticotropin,althoughhydrocortisonehastenedreversalofshockinpatientsinwhomshockwasreversed.
http://content.nejm.org/cgi/content/short/358/2/111
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