| objectiveChildren because of young age, poor resistance to infection, very susceptible to infectious diseases, so the infection of children, frequently-occurring disease, one of the common diseases. According to the different levels of infection, the infection can be divided into a common infection and severe infection. Common infection refers to infection confined to local:such as the surface of the skin, brain, lung, heart, becauseof local lesions, therefore, the damage caused by small, it is only local. Infection is more serious, causing a systemic inflammatory response, it becomes a severe infection, the site of the lesion damage, not only confined to the primary infection was part of, can also lead to other organ damage, these parts away from the primary site of infection distant and non-primary site of infection. Children with severe infections are one of the frequently questions of the pediatric intensive and also a major problem because it has a high morbidity and mortality. And the complication rate, part of the survival of children leave serious sequelae. Therefore, how active and effective treatment of severe infections in children is a major problem faced by the children’s intensive care unit (PICU).Children with severe infections can activate the hypothalamie-pituitary-adrenal axis (hypothalamie-pituitary-adrenal axis HPAA). This is the main factor to determine the host defense response, the adrenal gland into the adrenal cortex and medulla, and hypothalamic-pituitary-adrenal axis major role in the adrenal cortex, can stimulate the secretion of cortisol and cortisol on the one hand to the body’s stress response an important role,in the other hand can maintain a steady state of the body. When the body by infection, trauma, stress response, the body can drive a series of neuroendocrine reflex, allows HPAA activation, causing the secretion of glucocorticoids increase, which is one of the most important reactions in the body stress for the body against harmful stimuli plays a very important role.Glucocorticoids have an important role in the body,the one hand, it has an important role to sustain life, on the other hand involved in the body’s stress response is an essential part of the stress response. Under normal circumstances, the main role of glucocorticoids in order to maintain the stability of the loop function. When severe infection or stress, HPAA axis activation and glucocorticoid release expanded and increased. The main role of the glucocorticoid anti-inflammatory and immunosuppressive effects. It can be by acting on the nuclear transcription factor JB (NFJB) inhibit the synthesis of a variety of cytokines and inflammatory mediators. Such as tumor necrosis factor (TNF), interleukin1B (IL-1B), IL-2, IL-3, of IL-6, serotonin, bradykinin, histamine, and can reduce the arachidonic acid and platelet-activating factor reduce chemotaxis and adhesion effects. Also enhance the activity of some anti-inflammatory media, such as TNF receptor fusion protein of IL-10activity, IL-1receptor antagonist and so on. This anti-inflammatory and immunosuppressive effects of glucocorticoids to prevent the early activation of inflammatory cells, thereby blocking the "waterfall-like" chain reaction of inflammation, so reducing the damage of their own organization by the inflammatory mediators in the stress response to enable the body to enhance the stress tolerance.In addition, glucocorticoids can be induced cardiomyocyte Na+K+ATP enzyme activity, thereby enhancing the transcription and expression of the adrenergic receptor gene. Can inhibit the activity of inducible nitric oxide synthase (induciblenit ricoxide synthase, iNOS) and reduce the generation of nitric oxide (NO), is conducive to the recovery of circulatory function. Glucocorticoid with elevated blood sugar can increase the sugar to the transporter within the tissue cells and improve the organization of energy supply to meet metabolic needs.In this study, by the method of grouping the subjects were randomly divided into three groups to observe the group and one control group, three observation group patients admitted to hospital after the use of large medium small dose adrenal cortex hormone.The control group in addition to hormones, other drugs use are the same Detection of patients’ temperature, mental status, hemogram, CRP, cortisol, adrenocorticotropic hormone, recovery time and mortality, complications. Explore the severe infection in children with large medium small doses of adrenal corticosteroids, disease treatment, prognosis, mortality and complications. In order to provide a new target for severe infection in children with treatment.Research Methods1. Standard patient selection:The diagnostic criteria of severe infection in children as January2005, Pediatric Critical Care Medicine and in2005the group of pediatric branch of the Chinese Medical Association First Aid and Emergency Branch of Chinese Medical Association pediatric group of organizations, experts on China the specific circumstances of septic shock, the amendment of some indicators. Pediatric infectious lighter to re-divided into:infection, sepsis, severe sepsis, septic shock, organ dysfunction. The study of systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, organ dysfunction in children. Age:1month to14years of age; Gender:32males and28females, in which the diagnosis of sepsis in40cases, severe sepsis,8cases,10cases of septic shock, organ dysfunction two cases.2.Drugs:According to the children’s condition selected methylprednisolone, hydrocortisone, dexamethasone or times betamethasone, according to the condition applied in sufficient quantities2-3linked antibiotics.After the blood culture or culture susceptibility have a results, adjust antibiotics based on the results. Commonly used antibiotics penicillin, ampicillin sulbactam, cefuroxime, ceftriaxone, cefotaxime sodium, cefoperazone sulbactam, meropenem, Thailand can, fluconazole azithromycin and so on. Hormone, while the addition of calcium, potassium drugs. The commonly used drugs are calcium gluconate, the Diqiao calcium, potassium chloride solution.3.Groups:Select60cases of hospital pediatric patients with serious infections (all patients had obvious cause of the infection or lesions, fever, leukocytosis or reduce CRP increased percentage of neutrophils increased, are consistent with the child with severe infections diagnostic criteria) for the study were randomly divided into three groups to observe the group and one control group, n=15.4.Drug use:Three observation group patients admitted to hospital after the application of sufficient quantities of2-3linked antibiotics at the same time (24hours) were added with large, medium low-dose hormone therapy. Methylprednisolone: large doses6-10mg/kg/d, medium dose3-5mg/kg/d, small doses1-2mg/kg/d, divided into2doses; hydrocortisone:high-dose greater than10mg/kg/d, medium dose 5-10mg/kg/d, small doses3-5mg/kg/d; dexamethasone:large doses1-2mg/kg/d, medium dose0.5-1mg/kg, low dose0.3-0.5mg/kg/d. before application of methylprednisolone should be given ECG, blood pressure before use. While the addition of calcium, potassium drugs and myocardial protection and gastric mucosal drug. The control group in addition to hormones, before the remaining drugs are the same, the local treatment of localized disease who Hormone application3-5days after tapering according to the disease reduction after5-7days can be changed to oral or disabled.5.Drawn:Blood culture in children admitted to hospital before treatment, before the adrenal cortex hormones, blood to check blood count, ESR, CRP, cortisol, adrenocorticotropic corticosteroids; medication3-5days before the hormone reduction review; hormone reduction5-7days after the review, after the review of the disabled hormone.6.Observation Project:Observe the patients’ temperature, mental status, erythrocyte sedimentation rate, routine blood test, CRP, cortisol, adrenocorticotropic corticosteroids recovery. While observing the treatment of children with diseases, prognosis, mortality and complications.7.Technical means:Automatic biochemical analyzer, RIA experiments.Application of SPSS13.0software for statistical analysis of data, data x±s. Single factor analysis of variance comparison between groups, the difference between the groups significant between groups comparison SNK method or the Bonferroni method.Result1.Severe infection in children with adrenal cortex hormones is conducive to the recovery of the disease,various groups of inflammatory markers in clinical scores were compared with the control group significantly (P<0.05).2.Severe infection in children with large, medium and small doses of adrenal cortical hormone disease treatment was no significant difference.The two groups showed no significant difference (P>0.05).3.Severe infection in children with large doses of adrenal cortex hormones, complications compared with the application of small doses of adrenal corticosteroids, but no significant difference compared with group2(P>0.05).Conclusion 1.Severe infection in children with adrenal cortical hormone, is conducive to the recovery of the disease, and shorten the treatment of diseases, reduce the incidence of children with complications, lower mortality, reduce the sequelae and improve the quality of life of children.2.Large medium and small doses of adrenal cortical hormone treatment of the disease no significant difference, but children use large doses of adrenal have more complications than use the small doses of adrenal. |
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