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Objective:To analyze the clinical efficacy, the effect on prognosis and preliminarily discuss the mechanisms in which the low-dose of methylprednisolone used in early stage in Acute Lung Injury (ALI)/ Acute Respiratory Distress Syndrome (ARDS).Approach:There were 49 cases of mechanical ventilation according with ALI/ARDS diagnostic criteria in ICU of Xiangya Hospital from July 2009 to Feb 2010. We measure the cases serum cortisol by radioimmunoassay. The cases were randomly divided into treatment group and the placebo group through throwing coins. The treatment group was early given the low-dose methylprednisolone with intravenous therapy, as the placebo group was only with normal saline as placebo. Before treatment, the third and seventh day from treatment, we observed patients oxygenation index, lung injury score (Lung Injury Score), multiple organ dysfunction score (Multiple System Organ Dysfunction Score), sequential organ failure assessment score (Sequential Organ Failure Assessment Score), acute physiology and chronic health evaluation II (Acute Physiology And Chronic Health Evaluation II), C-reactive protein (C-reactive protein, CRP), duration of mechanical ventilation, incidence of infection, the incidence of gastrointestinal ulcers, critical illness neuromuscular disease, length of ICU stay,28 day mortality.Result:1.Comparing the treatment group with the placebo group, we found that:in the two groups there were no obvious differences in ages, sexes, lung conditions and respiratory parameters, body organ function scores. It also showed no significant difference in serum cortisol levels (25.2±1.1 vs 21.9±1.6,P=0.0725).2.The clinical indicators in the treatment group and the placebo group:we found that in the treatment group:compared with the placebo group, the indicators of the third day after treatment obviously improved rather than the day before treatment. The same to the seventh day compared with the third day after treatment. The differences between the third day after treatment and the day before treatment:oxygenation index on the rise (103.55±14.56 vs 65.57±18.43,P=0.000),LIS score decreased value (1.02±0.05 vs 0.41±0.04,P=0.000),MODS score decreased value (2.56±0.67 vs 1.14±0.56, P=0.000), SOFA score decreased value(1.89±1.03 vs 0.86±0.98,P=0.0008),APACHE II score decreased value (4.33±2.31 vs 2.98±1.99,P=0.0329),C-reactive protein decreased value(15.74±3.45 vs 10.21±2.58, P=0.000); the seventh day and the difference before and after the third day of monitoring indicators:oxygenation index increased (26.18+8.56 vs 11.42±4.34, P=0.000),LIS score decreased(0.52 +0.02 vs 0.43±0.04,P= 0.000),MODS score decreased value(1.88+0.33 vs 0.89±0.15,P= 0.000),SOFA score decreased(1.76+1.01 vs 1.19±0.67,P=0.0119), APACHE II score decreased (4.07±2.03 vs 2.76±1.77,P=0.0165), C-reactive protein decreased(12.60+3.12 vs 8.96±2.88, P=0.001). Reduce the length of mechanical ventilation(104.50±25.46h vs 127.25±35.34h, P=0.0139), treatment group decreased the length of ICU stay (168.33h vs 230.56h, P=0.0000).3.Incidences of side effects between the treatment group and the placebo group:the incidences of infection (21.74% vs 11.54%,P=0.5640), peptic ulcer (8.70% vs 3.85%,P=0.9127), critical illness neuromuscular disease (8.70% vs 3.85%,P=0.9127) are not significantly different.4. The outcome between the treatment group and the placebo group: 28 day’s mortality decreased in the treatment group (21.74% vs 50.00%, P=0.0406).5.In the placebo group, the mortality of patients whose the basal serum cortisol were less than 15ug/dl were higher than the ones whose the cortisol were more than 15ug/dl (72.73%vs 33.33%,P=0.0472), but in the treatment group, there were no obvious differences of the mortality between the two patients who had more or less level of the basal serum cortisol. (37.5%vs 13.33%,P=0.4193).Conclusion:Early given the low-dose methylprednisolone in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), the patients might gained affirmative effects. Not increasing the side effects, It could improve respiratory parameters, pulmonary function and other organs. We also reduced the duration of mechanical ventilation, the length of ICU stay and might decrease the 28-day mortality. The function of adrenal cortex may be one factor affecting the prognosis. Giving the methylprednisolone treatment and supplying the exogenous cortisol, may be the one of the mechanisms why produced therapeutic effects and improved the prognosis.
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