Clinical and Experimental Study of Septic Shock Lung
On the Usefulness of Corticosteroid
1984 Volume 58 Issue 11 Pages 1144-1160
Details
1984 Volume 58 Issue 11 Pages 1144-1160
The usefulness of corticosteroids for septic shock lung in accordance with some mecanismes of shock lung-developing were investigated.
1. In the endotoxin rabbits, peripheral PMNs were decreased immediately after endotoxin injection, and serum concentration of β-glucuronidase was increased. The edematous changes in endotoxin lung were suppressed by the pretreatment of Super Oxide Dismutase.These changes were not seen in the neutropenic animals made by premedcation of Nitrogen Mustard, in spite of the endotoxin injection.
In the clinical observation of 107 cases of gram negative sepsis, the incidence of shock lung was 28.8% in 93 patients whose leucocyte count was more than 3, 000/mm3, however any case of shock lungdeveloping was not seen in 14 patients whose peripherial leucocyte was less than 3, 000/mm3. From aboves, lysosomal enzyme and or Super Oxide, both of which are released from peripheral PMNs, may play an important role in the occurence of septic shock lung.
2. In animal examination, the increase in blood endotoxin, the decrease of peripheral PMNs, the increase in β-glucuronidase, the increase in volume of lymph flow and the mophologic changes in lung tissue were significantly suppresed by the administration of corticosteroids.
Twenty six patients of septic shock lung were analysed from view patients of their prognosis. In 18 cases, taking with steroids treatment, the mortality was 33%, but it was 75% in 8 cases of non-steroid one. There was stastical significance between them. Above all, the steroid therapy was more effective in patients when it was administrated at early stage of the shock lung. In five cases, the steroid therapy was started at the stage of pre-shock lung, accordance with the predict sign of shock lung that were previously reported by our group. The shock lung-developing was prevented in all five cases.
3. From above, corticosteroids might be suppressed the early stage in the course of the shock lungdeveloping, therefore corticosteroids might be useful drug for septic shock lung when it is used at earlier stage of this syndrome.
