[The effect of low-dose hydrocortisone on requirement of norepinephrine and lactate clearance in patients with refractory septic shock].
OBJECTIVE
To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply.


METHODS
Seventy-seven septic shock patients with hypotension refractory to fluids and administration of norepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure (MAP), lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment.


RESULTS
The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups (all P<0.01). Compare to the control group, the course of using norepinephrine was shorter and the number of using norepinephrine was smaller in 7 days in treatment group (both P<0.05 ); the MAP and lactate clearance were higher in 24 hours and 7 days in treatment group (P<0.05 or P<0.01). But there were no differences in mortality and the length of stay in intensive care unit (ICU).


CONCLUSIONS
For the patients with septic shock with refractory hypotension, low-dose hydrocortisone can decrease the time course and dosage of vasopressors, improve tissue oxygen supply, thus can reverse septic shock more rapidly.
Hu
Bo
B
Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Li
Jian-guo
JG
Liang
Hui
H
Zhou
Qing
Q
Yu
Zhui
Z
Li
Lu
L
Luo
Yun
Y
Liu
Chang
C
Gan
Quan
Q
D000293:Adolescent; D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000627:therapeutic use; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D012772:Shock, Septic / Q000188:drug therapy* / Q000378:metabolism; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D006854:Hydrocortisone; D009638:Norepinephrine