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首页> 外文期刊>Critical care : >Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial
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Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial

机译：氢化可的松的给药方式对败血性休克患者血糖控制的影响：一项前瞻性随机试验

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IntroductionLow-dose hydrocortisone treatment is widely accepted therapy for the treatment of vasopressor-dependent septic shock. The question of whether corticosteroids should be given to septic shock patients by continuous or by bolus infusion is still unanswered. Hydrocortisone induces hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach.MethodsIn this prospective randomized study, we compared the blood glucose profiles, insulin requirements, amount of nursing workload needed, and shock reversal in 48 septic shock patients who received hydrocortisone treatment either by bolus or by continuous infusion with equivalent dose (200 mg/day). Duration of hydrocortisone treatment was five days.ResultsThe mean blood glucose levels were similar in the two groups, but the number of hyperglycemic episodes was significantly higher in those patients who received bolus therapy (15.7 ± 8.5 versus 10.5 ± 8.6 episodes per patient, p = 0.039). Also, more changes in insulin infusion rate were needed to maintain strict normoglycemia in the bolus group (4.7 ± 2.2 versus 3.4 ± 1.9 adjustments per patient per day, p = 0.038). Hypoglycemic episodes were rare in both groups. No difference was seen in shock reversal.ConclusionStrict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion. This approach also reduces nursing workload needed to maintain tight blood glucose control. Trial Registration Number ISRCTN98820688
机译：简介小剂量氢化可的松疗法是治疗血管加压药依赖性败血性休克的广泛接受的疗法。是否应通过持续或推注输注给败血性休克患者使用皮质类固醇激素的问题仍未得到解答。氢化可的松可诱发高血糖症，连续氢化可的松输注可能会降低血糖水平的波动，并且通过这种方法可以更好地实现严格的血糖控制。方法在这项前瞻性随机研究中，我们比较了血糖分布，胰岛素需求量，剂量48名脓毒症休克患者（通过推注或等剂量（200 mg /天）连续输注）接受氢化可的松治疗后，需要的护理工作量和休克逆转情况。氢化可的松治疗时间为5天。结果两组的平均血糖水平相似，但是接受推注治疗的患者的高血糖发作次数明显更高（每位患者15.7±8.5对10.5±8.6次，p = 0.039）。另外，在推注组中需要更多的胰岛素输注速率变化以维持严格的正常血糖水平（每位患者每天调整4.7±2.2对3.4±1.9，p = 0.038）。两组均很少出现降血糖发作。结论持续性输注败血性休克患者接受氢化可的松治疗，可以更容易实现严格的血糖正常化。这种方法还减少了维持严格血糖控制所需的护理工作量。试用注册号ISRCTN98820688

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