小剂量氢化可的松对感染性休克患者房颤的影响

doi:10.3969/j.issn.1002-1949.2018.06.003

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (6): 476- DOI: 10.3969/j.issn.1002-1949.2018.06.003

Effect of low-dose hydrocortisone on atrial fibrillation in patients with septic shock

Li Yan-chan, Zheng Hong-mei, Du Xue-ping, Zhao Ya-zhi, Li Jian-min

Abstract
Figure/Table
References (15)
Related Citation (15)

Download: PDF (665 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To evaluate the effect of low-dose hydrocortisone on the incidence of atrial fibrillation (AF) in septic shock patients. Methods 299 patients with septic shock who were treated with ICU were enrolled. All patients were treated with active anti-infection and fluid resuscitation. Patients with vasoactive drugs and adequate fluid resuscitation were treated with hydrocortisone sodium succinate injection intravenously, 200 mg/d, continuous infusion for 7 days, afterwards, the dose was decreased. The patients were divided into hydrocortisone group (n=156) and non-hydrocortisone (n=143) group according to whether they were treated with hydrocortisone. The clinical data of patients admitted to hospital, the incidence of AF, hydrocortisone treatment and prognosis of patients were compared. The variable that P≤0.20 in univariate analyses as covariates was selected. A propensity score weighted Logistic regression analysis of patient AF incidence was performed to evaluate the risk factors of AF. Results The patients in the non-hydrocortisone group and the hydrocortisone group had 37 (23.7%) and 28 (19.6%) patients with AF respectively. The propensity score weighted Logistic regression analysis showed that the incidence of AF was 28.9% and 16.7% in non-hydrocortisone and hydrocortisone groups, respectively. The incidence of AF was significantly lower in patients with acute septic shock treated with low-dose hydrocortisone (OR=-11.9%, 95%CI:-23.4%～-0.5%,P=0.040). Conclusion Low-doses hydrocortisone can reduce the risk of developing AF in septic shock.

Key words： Septic shock Atrial fibrillation(AF) Hydrocortisone

About author:: Li Yan-chan, E-mail: marrylixzh@sina.com

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Li Yan-chan
	Zheng Hong-mei
	Du Xue-ping
	Zhao Ya-zhi
	Li Jian-min

Cite this article:

Li Yan-chan,Zheng Hong-mei,Du Xue-ping, et al. Effect of low-dose hydrocortisone on atrial fibrillation in patients with septic shock[J]. Chinese Journal of Critical Care Medicine, 2018, 38(6): 476-.

URL:

http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.06.003 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I6/476

［1］蹇在金，刘岁丰. 老年房颤患者的抗栓治疗［J］.中华老年心血管病杂志, 2013， 15(8): 785-786. ［2］陈桂浩，杨跃进. 利伐沙班在特殊人群房颤中的研究进展［J］.中华医学杂志, 2017， 97(26): 2078-2080.  ［3］Meierhenrich R, Steinhilber E, Eggermann C, et al. Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock: a prospective observational study［J］. Crit Care, 2010, 14(3): R108. ［4］Guenancia C, Binquet C, Laurent G, et al. Incidence and Predictors of New-Onset Atrial Fibrillation in Septic Shock Patients in a Medical ICU: Data from 7-Day Holter ECG Monitoring［J］. PLoS One, 2015, 10(5): e0127 168. ［5］吕清泉，孙昊，吕应鸣，等. 小剂量糖皮质激素在治疗脓毒性休克中的应用进展［J］.中华临床感染病杂志, 2016， 9(3): 284-288.［6］Gialdini G, Nearing K, Bhave PD, et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke［J］. JAMA, 2014, 312(6): 616-622. ［7］Shaver CM, Chen W, Janz DR, et al. Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients［J］. Crit Care Med, 2015, 43(10): 2104-2111. ［8］Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock［J］. JAMA, 2002, 288(7): 862-871. ［9］Hu YF, Chen YJ, Lin YJ, et al. Inflammation and the pathogenesis of atrial fibrillation［J］. Nat Rev Cardiol, 2015, 12(4): 230-243.〖ZK)〗 ［10］Raiten JM, Ghadimi K, Augoustides JG, et al. Atrial fibrillation after cardiac surgery: clinical update on mechanisms and prophylactic strategies［J］. J Cardiothorac Vasc Anesth, 2015, 29(3): 806-816. ［11］Dieleman JM, Nierich AP, Rosseel PM, et al. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial［J］. JAMA, 2012, 308(17): 1761-1767. ［12］Angus DC, van der Poll T. Severe sepsis and septic shock［J］. N Engl J Med, 2013, 369(9): 840-851. ［13］Keh D, Boehnke T, Weber-Cartens S, et al. Immunologic and hemodynamic effects of "low-dose" hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study［J］. Am J Respir Crit Care Med, 2003, 167(4): 512-520. ［14］Ambrus DB, Benjamin EJ, Bajwa EK, et al. Risk factors and outcomes associated with new-onset atrial fibrillation during acute respiratory distress syndrome［J］. J Crit Care, 2015, 30(5): 994-997. ［15］Walkey AJ, Hammill BG, Curtis LH, et al. Long-term outcomes following development of new-onset atrial fibrillation during sepsis［J］. Chest, 2014, 146(5): 1187-1195.