| Objective: Septci shock is one of the leading causes of death in ICU and the incidence has a rising trend year by year. Despite the treatment of septic shock measures and technical progress, but mortality remains high. With respect to its reason, the pathogenesis of sepsis is very complex, involves multiple systems,such as the immune, neuroendocrine and blood coagulation system and so on. The inflammatory response and immune dysfunction are important pathogenesis of septic shock. Studies have shown that septic shock is the result of the transition of the systemic inflammatory response was deteriorated, the dynamic balance of anti-inflammatory medium and proinflammatory medium decides the development of septic shock. Excessive activation and inflammatory markers disorder can lead to multiple organ function failure and death, the serious influence the prognosis of patients.Immune dysfunction in patients with septic shock mainly was cell immunosuppression, characterized by bacterial clearance delay, concurrent secondary infection, thus increasing case fatality rate in patients with septic shock. CD4+cells are auxiliary lymphocytes, can secrete cytokines, have adjust the function of cellular immunity, sepsis is the main reason for decline in immune function of patients with shock. Therefore, how to better control the inflammatory response in patients with septic shock, regulate the body’s immune dysfunction is one of an important part of the treatment of sepsis shock patients.Adrenal glucocorticoid could s Tableilize cell membrane, lysosome membrane and mast cell membrane, protect the role of endothelial cell function, plays an important role by against excessive activation of the immune system in the process of responding to systemic inflammation. Sepsisguidelines recommend that patients with septic shock who was no response to adequate fluid resuscitation and vascular active drug was given low dose of glucocorticoid treatment, could improve the hemodynamics of patients, reduce the case fatality rate. But the application of low-dose glucocorticoids remains controversial. different time used low dose of glucocorticoid hemodynamics in patients with septic shock, the influence of the inflammatory factors and immune function has not yet been reported. This study was to explore the effect of early low dose glucocorticoid on the influence of inflammatory cytokines, immune function and prognosis in patients with septic shock. It will provide theoretical basis and clinical experience for early intervention and treatment in patients with septic shock,improve the prognosis of patients.Methods:1 Sixty patients with septic shock were enrolled from June 2013- August2015 in ICU of our hospital, were divided into Control group, Early hormone treatment group and Late treatment group 3 subgroups on the basis of low-dose of hormone application time. Control group: normal anti-infection,nutritional support, and other comprehensive treatment; Early hormone treatment group(n=25): general anti-infection, nutritional support, and low dose of hydrocortisone was administrated(50 mg,Q6 h, 7 days) in septic shock within 6h;Late hormone treatment group(n=16): general anti-infection,nutritional support, and low dose of hydrocortisone was administrated(50mg,Q6 h, 7 days) in septic shock within 24 h. Also the same health check-up 30 cases were enrolled as Normal control group. All patients with septic shock were measured the heart rate, mean arterial pressure(MAP), oxygenation index(PO2/FIO2) and the detection of blood gas analysis and blood lactic acid level at pre and pro treatment of 12 h, 24 h, 48 h. All were detected liver and kidney function, serum IL-6, IL-10 levels, the expression of peripheral blood mononuclear cells HLA- DR and peripheral blood CD4 + cells apoptosis rate at pre and pro treatment of 1d, 3d, 7d. All patients with septic shock were counted the ICU time, mechanical ventilation time, length of hospital stay and mortality of 28 days.2SPSS 17.0 statistical analysis software was used for statistical analysis.Data with mean +/-standard deviation(+/-s) said, repeated measurement data using the single factor analysis of variance of repeated measurement data,SNK method are compared, and two categorical data using x2 test, P < 0.05 for statistical significance.Results:1 Serum IL-6, IL-10 level were obviously higher in Septic shock group than that of Normal control group, the difference was statistically significant(P<0.05). Peripheral blood CD4+cells apoptosis rate in Septic shock group increased significantly than that of Normal control group, the expression of peripheral blood mononuclear cells HLA-DR levels was significantly lower than that of Normal control group, the difference was statistically significant(P < 0.05).2 Apache Ⅱ and Sofa scores had no statistical difference between early hormone group, late hormone groups and Control group before treatment.Apache Ⅱ and Sofa scores was significantly decreased after treatment at 1d,3d and 7d in all three groups, Apache Ⅱ and Sofa scores decreased gradually,the difference was statistically significant. After treatment between groups:Apache Ⅱ and Sofa scores significantly were lower in Early hormone group and Late hormone group than Control group after treatment at 1d, 3d and 7d,the difference was statistically significant(P<0.05). Apache Ⅱ and Sofa scores obviously decreased in Early hormone group than that of Late hormone group after treatment at 1d, 3d and 7d, the difference was statistically significant(P<0.05).3 MAP, HR, PO2/FIO2 and blood lactate level was obviously improved after treatment at 12 h, 24 h, 48 h in three groups, the difference was statistically significant(P<0.05). Comparison between groups, MAP, PO2/FIO2, blood lactic acid level significantly improved in Early hormone group than that of Late hormone group and Control group after treatment at 12 h, 24 h, 48 h, the difference was statistically significant(P < 0.05). MAP, PO2/FIO2, blood lactic acid level had no statistically significant between Late hormone group andControl group after treatment at 12 h, 24 h, 48 h. HR obviously improved in Early hormone group and Late hormone group than that of Control group after treatment at 12 h, 24 h, 48 h, the difference was statistically significant(P<0.05).HR obviously improved in Early hormone group than that of Late hormone group after treatment at 48 h, the difference was statistically significant(P<0.05).4 Serum IL- 6, IL- 10 levels were obviously lower after treatment at 1d,3d and 7d in three groups, the difference was statistically significant(P<0.05).Comparison between groups, Serum IL-6 level in Early hormone group than that of Late hormone group and Control group after treatment at 1d, 3d and 7d,the difference was statistically significant(P<0.05). Serum IL-6 level decreased obviously in Early hormone group than that of Late hormone group after treatment at 1d, 3d and 7d,the difference was statistically significant(P<0.05). Serum IL-10 level has no statistical difference between Early hormone group, Late hormone group and Control group.5 Peripheral blood CD4+ cells apoptosis rate significantly decreased pro-treatment than that of pre-treatment, and gradually decreased with the time,the difference was statistically significant(P<0.05). Comparison between groups, Peripheral blood CD4+ cells apoptosis rate was significantly decreased in Early hormone group and Late hormone group than that of Control group after treatment at 3d and 7d, the difference was statistically significant(P<0.05). Peripheral blood CD4+ cells apoptosis rate was decreased obviously in Early hormone group than that of Late hormone group after treatment at3 d and 7d, the difference was statistically significant(P<0.05).6 Peripheral blood mononuclear cells HLA-DR level significantly increased pro-treatment than that of pre-treatment, and gradually decreased with the time, the difference was statistically significant(P<0.05). Peripheral blood mononuclear cells HLA-DR level has no statistical difference between Early hormone group, Late hormone group and Control group.7 Mechanical ventilation time,stay ICU time,Hospital stays and vascular active drug application time were obviously shorthen in Early hormone groupand Late hormone group than that of Control group, the difference was statistically significant(P<0.05). Mechanical ventilation time,stay ICU time,Hospital stays and vascular active drug application time were obviously shorthen in Early hormone group than that of Late hormone group, the difference was statistically significant(P<0.05). The mortality of 28 days in Early hormone group, Late hormone groupand Control group had no significant statistical difference.8 Shock recurrence in hospital, arrhythmia, gastrointestinal bleeding,blood glucose(blood sugar≥10mmol/L) and the incidence of fungal infection had no significant statistical difference.Conclusion:1 The early low-dose glucocorticoids could significantly reduce ApacheⅡ and Sofa socres in patients with septic shock,protect organ function.2 The early low-dose glucocorticoids could improve quickly hemodynamics, PO2/FIO2 and blood lactic acid level in patients with septic shock.3 The early low-dose glucocorticoids could effectively reduce the inflammatory response in patients with septic shock, but had no obvious effect on Serum of IL-10 level.4 Early small dose glucocorticoid can reduce the apoptosis rate of CD4+cells, but the expression level of HLA-DR in peripheral blood mononuclear cells had no obvious effect, the early low-dose of corticosteroids had no obviously inhibited on the immune function of patients with septic shock.5 The early low-dose of corticosteroids could shorten the time of Mechanical ventilation, Stay ICU time and Length of hospital,but had no effect on the mortality of 28 days.6 The early low-dose of corticosteroids could not increase the incidence of complications in the treatment of septic shock patients. |
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