Внутривенный гидрокортизон не улучшает выживаемость больных с септическим шоком
§°§д§Я§а§к§Ц§Я§Ъ§Ц §Ь §Я§С§Щ§Я§С§й§Ц§Я§Ъ§р §Ф§Э§р§Ь§а§Ь§а§в§д§Ъ§Ь§а§Ъ§Х§а§У §б§в§Ъ §г§Ц§б§д§Ъ§й§Ц§г§Ь§а§Ю §к§а§Ь§Ц §б§в§Ц§д§Ц§в§б§Ц§Э§а §в§С§Х§Ъ§Ь§С§Э§о§Я§н§Ц §Ъ§Щ§Ю§Ц§Я§Ц§Я§Ъ§с §Я§Ц§а§Х§Я§а§Ь§в§С§д§Я§а: §а§д §У§Я§е§д§в§Ъ§У§Ц§Я§Я§а§Ф§а §У§У§Ц§Х§Ц§Я§Ъ§с §У §У§н§г§а§Ь§Ъ§з §Х§а§Щ§С§з §Х§а §б§а§Э§Я§а§Ф§а §а§д§в§Ъ§и§С§Я§Ъ§с. §Ј §Я§С§г§д§а§с§л§Ц§Ц §У§в§Ц§Ю§с §г§д§Ц§в§а§Ъ§Х§Я§н§Ц §Ф§а§в§Ю§а§Я§н §У§У§а§Х§Ъ§д§о §в§Ц§Ь§а§Ю§Ц§Я§Х§е§р§д, §Я§а §Ъ§Ю§Ц§Я§Я§а §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я §Ъ §У §Я§Ц§Т§а§Э§о§к§Ъ§з §Х§а§Щ§С§з. §Ґ§а§Ь§С§Щ§С§д§Ц§Э§о§Я§С§с §Т§С§Щ§С §б§а§Х §д§С§Ь§а§Ы §в§Ц§Ь§а§Ю§Ц§Я§Х§С§и§Ъ§Ц§Ы §Я§Ц§а§Х§Я§а§Щ§Я§С§й§Я§С. §®§Ц§Ш§Х§е§Я§С§в§а§Х§Я§н§Ы §Ь§а§Э§Э§Ц§Ь§д§Ъ§У §Ъ§г§г§Э§Ц§Х§а§У§С§д§Ц§Э§Ц§Ы §Ъ§Щ §г§д§в§С§Я §¦§У§в§а§б§н §Ъ §Є§Щ§в§С§Ъ§Э§с §б§в§а§У§Ц§Э §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§Ц §Я§С §п§д§е §д§Ц§Ю§е §Ъ §а§б§е§Т§Э§Ъ§Ь§а§У§С§Э §в§Ц§Щ§е§Э§о§д§С§д§н §г§У§а§Ц§Ы §в§С§Т§а§д§н §У New England Journal of Medicine §Щ§С 10 §с§Я§У§С§в§с 2008 §Ф.
§®§Ц§д§а§Х§н §Ъ §з§а§Х §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§с.
§Є§г§г§Э§Ц§Х§а§У§С§Я§Ъ§Ц CORTICUS (Corticosteroid Therapy of Septic Shock, §Э§Ц§й§Ц§Я§Ъ§Ц §г§Ц§б§д§Ъ§й§Ц§г§Ь§а§Ф§а §к§а§Ь§С §Ь§а§в§д§Ъ§Ь§а§г§д§Ц§в§а§Ъ§Х§С§Ю§Ъ) §Т§н§Э§а §б§в§а§У§Ц§Х§Ц§Я§а §Ь§С§Ь §в§С§Я§Х§а§Ю§Ъ§Щ§Ъ§в§а§У§С§Я§Я§а§Ц §Х§У§а§Ы§Я§а§Ц §г§Э§Ц§б§а§Ц §Ь§а§Я§д§в§а§Э§Ъ§в§а§У§С§Я§Я§а§Ц §Ъ§г§б§н§д§С§Я§Ъ§Ц, §б§в§а§з§а§Х§Ъ§У§к§Ц§Ц §У 52 §а§д§Х§Ц§Э§Ц§Я§Ъ§с§з §в§Ц§С§Я§Ъ§Ю§С§и§Ъ§Ъ. §Ј§Ь§Э§р§й§Ц§Я§Ъ§Ц §У §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§Ц §б§в§а§з§а§Х§Ъ§Э§а §г §Ю§С§в§д§С 2002 §б§а §Я§а§с§Т§в§о 2005. §¬§в§Ъ§д§Ц§в§Ъ§Ъ: §У§а§Щ§в§С§г§д ЎЭ 18 §Э§Ц§д, §б§в§Ъ§Щ§Я§С§Ь§Ъ §Ъ§Я§ж§Ц§Ь§и§Ъ§Ъ, §г§Ъ§г§д§Ц§Ю§Я§а§Ф§а §а§д§У§Ц§д§С §Я§С §Ъ§Я§ж§Ц§Ь§и§Ъ§р §Ъ §г§Ц§б§д§Ъ§й§Ц§г§Ь§а§Ф§а §к§а§Ь§С §У §д§Ц§й§Ц§Я§Ъ§Ц §б§а§г§Э§Ц§Х§Я§Ъ§з 72§й (§Ў§Ґ <90§Ю§Ю §в§д.§г§д. §Я§Ц§г§Ю§а§д§в§с §Я§С §С§Х§Ц§Ь§У§С§д§Я§е§р §Ш§Ъ§Х§Ь§а§г§д§Я§е§р §д§Ц§в§С§б§Ъ§р §Ъ§Э§Ъ §б§а§д§в§Ц§Т§Я§а§г§д§о §У §У§С§Щ§а§б§в§Ц§г§г§а§в§С§з §Ю§Ъ§Я§Ъ§Ю§е§Ю §а§Х§Ъ§Я §й§С§г), §Ф§Ъ§б§а§б§Ц§в§ж§е§Щ§Ъ§с §У§Я§е§д§в§Ц§Я§Я§Ъ§з §а§в§Ф§С§Я§а§У, §У§н§Щ§У§С§Я§Я§С§с §г§Ц§б§г§Ъ§г§а§Ю. §і§в§Ц§Х§Ъ §Ь§в§Ъ§д§Ц§в§Ъ§Ц§У §Ъ§г§Ь§Э§р§й§Ц§Я§Ъ§с: §У§н§г§а§Ь§Ъ§Ы §в§Ъ§г§Ь §г§Ю§Ц§в§д§Ъ §У §б§Ц§в§У§н§Ц §г§е§д§Ь§Ъ §б§а §а§г§Я§а§У§Я§а§Ю§е §Щ§С§Т§а§Э§Ц§У§С§Я§Ъ§р, §Ъ§Ю§Ю§е§Я§а§г§е§б§в§Ц§г§г§Ъ§с §Ъ §Ь§а§в§д§Ъ§Ь§а§г§д§Ц§в§а§Ъ§Х§н §Х§Э§Ъ§Я§Я§н§Ю §Ь§е§в§г§а§Ю §У §б§а§г§Э§Ц§Х§Я§Ъ§Ц 6 §Ю§Ц§г§с§и§Ц§У, §Ъ§Э§Ъ §Ь§а§в§а§д§Ь§Ъ§Ю §Ь§е§в§г§а§Ю §У §б§а§г§Э§Ц§Х§Я§Ъ§Ц §й§Ц§д§н§в§Ц §Я§Ц§Х§Ц§Э§Ъ.
§±§С§и§Ъ§Ц§Я§д§а§У §в§С§Я§Х§а§Ю§Ъ§Щ§Ъ§в§а§У§С§Э§Ъ §Я§С §Э§Ъ§Т§а §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я (hydrocortisone, §Ь§а§Ю§б§С§Я§Ъ§Ъ Rotexmedica), §Т§а§Э§р§г§С§Ю§Ъ §б§а 50 §Ю§Ф §Ь§С§Ш§Х§н§Ц 6 §й§С§г§а§У 5 §г§е§д§а§Ь, §Щ§С§д§Ц§Ю §й§Ц§в§Ц§Щ 12 §й§С§г§С §г 6 §б§а 8 §Х§Ц§Я§о, §й§Ц§в§Ц§Щ 24§й§С§г§С §г 9 §б§а 11 §Х§Я§Ъ, §д.§Ц. §У§г§Ц§Ф§а 29 §Х§а§Щ, §Э§Ъ§Т§а §Я§С §б§Э§С§и§Ц§Т§а. §±§в§а§Ъ§Щ§У§а§Х§Ъ§Э§С§г§о §Ь§а§в§а§д§Ь§С§с §г§д§Ъ§Ю§е§Э§с§и§Ъ§с §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я§а§Ю: §У§У§а§Х§Ъ§Э§Ъ §У§У§Ц§Х§Ц§Я§Ъ§с 0.25 §Ю§Ф §Ь§а§г§Ъ§Я§д§в§а§б§Ъ§Я§С (cosyntropin), §г§в§С§У§Я§Ъ§У§С§Э§Ъ §Ь§а§в§д§Ъ§Щ§а§Э §Ь§в§а§У§Ъ §Х§а §Ъ §й§Ц§в§Ц§Щ 60 §Ю§Ъ§Я§е§д §б§а§г§Э§Ц §У§У§Ц§Х§Ц§Я§Ъ§с. §І§Ц§Щ§е§Э§о§д§С§д §г§й§Ъ§д§С§Э§г§с §а§д§в§Ъ§и§С§д§Ц§Э§о§Я§н§Ю, §Ц§г§Э§Ъ §Ь§а§в§д§Ъ§Щ§а§Э §У §Ь§в§а§У§Ъ §б§а§У§н§к§С§Э§г§с §Я§Ц §Т§а§Э§Ц§Ц §й§Ц§Ю §Я§С 248 §Я§Ю/§Э. §°§г§Я§а§У§Я§С§с §Ь§а§Я§Ц§й§Я§С§с §д§а§й§Ь§С: §Э§Ц§д§С§Э§о§Я§а§г§д§о §Я§С 28 §Х§Ц§Я§о §е §б§С§и§Ъ§Ц§Я§д§а§У §г §а§д§г§е§д§г§д§У§Ъ§Ц§Ю §в§Ц§С§Ь§и§Ъ§Ъ §Я§С §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я. §і§в§Ц§Х§Ъ §У§д§а§в§Ъ§й§Я§н§з §Ь§а§Я§Ц§й§Я§н§з §д§а§й§Ц§Ь: 28-§Х§Я§Ц§У§Я§С§с §Э§Ц§д§С§Э§о§Я§а§г§д§о §е §б§С§и§Ъ§Ц§Я§д§а§У, §г§в§Ц§С§Ф§Ъ§в§а§У§С§У§к§Ъ§з §Я§С §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я, §Э§Ц§д§С§Э§о§Я§а§г§д§о §в§Ц§С§Я§Ъ§Ю§С§и§Ъ§а§Я§Я§С§с §Ъ §Ф§а§г§б§Ъ§д§С§Э§о§Я§С§с, §С §д§С§Ь§Ш§Ц §У §д§Ц§й§Ц§Я§Ъ§Ц §Ф§а§Х§С §б§а§г§Э§Ц §в§С§Я§Х§а§Ю§Ъ§Щ§С§и§Ъ§Ъ, §г§Ь§а§в§а§г§д§о §У§а§г§г§д§С§Я§а§У§Э§Ц§Я§Ъ§с §а§в§Ф§С§Я§Я§а§Ы §Я§Ц§Х§а§г§д§С§д§а§й§Я§а§г§д§Ъ, §Х§Э§Ъ§д§Ц§Э§о§Я§а§г§д§о §б§в§Ц§Т§н§У§С§Я§Ъ§с §У §в§Ц§С§Я§Ъ§Ю§С§и§Ъ§Ъ §Ъ §У §г§д§С§и§Ъ§а§Я§С§в§Ц.
§І§Ц§Щ§е§Э§о§д§С§д§н.
§Ј §С§Я§С§Э§Ъ§Щ §б§а §Я§С§Щ§Я§С§й§Ц§Я§Я§а§Ю§е §Э§Ц§й§Ц§Я§Ъ§р §У§а§к§Э§Ъ 499 §Т§а§Э§о§Я§н§з; 251 §Т§а§Э§о§Я§а§Ы §Т§н§Э §в§С§Я§Х§а§Ю§Ъ§Щ§Ъ§в§а§У§С§Я §Я§С §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я, 248 - §Я§С §б§Э§С§и§Ц§Т§а. 87% §У §а§Т§Ц§Ъ§з §Ф§в§е§б§б§С§з §б§а§Э§е§й§Ъ§Э§Ъ §Ю§Ъ§Я§Ъ§Ю§е§Ю 90% §Х§а§Щ §Ъ§г§г§Э§Ц§Х§е§Ц§Ю§а§Ф§а §б§в§Ц§б§С§в§С§д§С. §°§д§в§Ъ§и§С§д§Ц§Э§о§Я§н§Ы §а§д§У§Ц§д §Я§С §г§д§Ъ§Ю§е§Э§с§и§Ъ§р §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я§а§Ю §а§д§Ю§Ц§й§Ц§Я §е 233 (46.7%) §Т§а§Э§о§Я§н§з, 125 - §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С, 108 ЁC §б§Э§С§и§Ц§Т§а. §і§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а §е 8 §Ъ §е 4 §в§Ц§Щ§е§Э§о§д§С§д §б§в§а§Т§н §г §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§а§Ю §Я§Ц§Ъ§Щ§У§Ц§г§д§Ц§Я. §ї§д§а§Ю§Ъ§Х§С§д (etomidate),
§У/§У §С§Я§Ц§г§д§Ц§д§Ъ§Ь §Ь§а§в§а§д§Ь§а§Ф§а §Х§Ц§Ы§г§д§У§Ъ§с, §д§а§в§Ю§а§Щ§с§л§Ъ§Ы §г§Ъ§Я§д§Ц§Щ §Ф§а§в§Ю§а§Я§а§У §У §Ь§а§в§Ц §Я§С§Х§б§а§й§Ц§й§Я§Ъ§Ь§а§У, §б§а§Э§е§й§Ъ§Э§Ъ 51/251 (20.3%) §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С §Ъ 45/248(18.1%) §У §Ф§в§е§б§б§Ц §б§Э§С§и§Ц§Т§а §Х§а §в§С§Я§Х§а§Ю§Ъ§Щ§С§и§Ъ§Ъ §Ъ §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а 22 (8.8%) §Ъ 20 (8.1%) §б§а§г§Э§Ц §в§С§Я§Х§а§Ю§Ъ§Щ§С§и§Ъ§Ъ. §Є§Щ §п§д§Ъ§з 96 §б§С§и§Ъ§Ц§Я§д§а§У §а§д§в§Ъ§и§С§д§Ц§Э§о§Я§С§с §б§в§а§Т§С §г§д§Ъ§Ю§е§Э§с§и§Ъ§Ъ §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я§а§Ю §а§д§Ю§Ц§й§Ц§Я§С §е 58 (60.4%), §б§а §г§в§С§У§Я§Ц§Я§Ъ§р §г§а 175/403 (43.4%, §в=0.004) §Т§а§Э§о§Я§н§Ю§Ъ, §Ь§а§д§а§в§н§Ц §Я§Ц §б§а§Э§е§й§Ъ§Э§Ъ §п§д§а§Ю§Ъ§Х§С§д§С.§±§а §Ъ§г§з§а§Х§Я§н§Ю §Ь§Э§Ъ§Я§Ъ§Ь§а-§Х§Ц§Ю§а§Ф§в§С§ж§Ъ§й§Ц§г§Ь§Ъ§Ю §Х§С§Я§Я§н§Ю §Ф§в§е§б§б§н §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С §Ъ §б§Э§С§и§Ц§Т§а §Т§н§Э§Ъ §з§а§в§а§к§а §г§Т§С§Э§С§Я§г§Ъ§в§а§У§С§Я§н: §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а §У§а§Щ§в§С§г§д 63ЎА14 §Ъ 63ЎА15 §Э§Ц§д, §Ю§е§Ш§й§Ъ§Я - 66% §Ъ 67%, §Т§а§Э§о§Я§н§з §Т§Ц§Э§а§Ы §в§С§г§н - 94% §Ъ 92%, §Я§Ц-§з§Ъ§в§е§в§Ф§Ъ§й§Ц§г§Ь§а§Ф§а §б§в§а§ж§Ъ§Э§с - 32% §Ъ 38%, §а§б§Ц§в§Ъ§в§а§У§С§Я§н§з §б§а §Я§Ц§а§д§Э§а§Ш§Я§н§Ю §б§а§Ь§С§Щ§С§Я§Ъ§с§Ю - 55% §Ъ 54%, §б§а§г§Э§Ц §б§Э§С§Я§а§У§а§Ы §а§б§Ц§в§С§и§Ъ§Ъ - 12% §Ъ 9%.
§±§а §а§г§Я§а§У§Я§а§Ю§е §Ъ§г§з§а§Х§е (28 §Х§Я§Ц§У§Я§С§с §Э§Ц§д§С§Э§о§Я§а§г§д§о §г§в§Ц§Х§Ъ §Я§Ц §а§д§У§Ц§д§Ъ§У§к§Ъ§з §Я§С §б§в§а§Т§е §г §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я§а§Ю) §в§С§Щ§Э§Ъ§й§Ъ§Ы §Ю§Ц§Ш§Х§е §Ф§в§е§б§б§С§Ю§Ъ §Я§Ц §Т§н§Э§а. §µ§Ю§Ц§в§Э§Ъ 49/125 §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С (39.2%, 95% §Х§а§У§Ц§в§Ъ§д§Ц§Э§о§Я§н§Ы §Ъ§Я§д§Ц§в§У§С§Э, §Ґ§Є 30.5-47.9%) §Ъ 39/108 §У §Ф§в§е§б§б§Ц §б§Э§С§и§Ц§Т§а (36.1%, 95%§Ґ§Є 26.9-45.3%, §в=0.69). §і§в§Ц§Х§Ъ §г§в§Ц§С§Ф§Ъ§в§а§У§С§У§к§Ъ§з §Я§С §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я 28 §Х§Я§Ц§У§Я§С§с §Э§Ц§д§С§Э§о§Я§а§г§д§о §д§С§Ь§Ш§Ц §Я§Ц §в§С§Щ§Э§Ъ§й§С§Э§С§г§о: §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а, 34/118 (28.8%, 95%§Ґ§Є 20.6-37.0%) §Ъ 39/136 (28.7%, 95%§Ґ§Є 21.1-36.3%, §в=1.00). §Ј§г§Ц§Ф§а §Ь 28 §Х§Я§р §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С §е§Ю§Ц§в§Э§Ъ 86 §Т§а§Э§о§Я§н§з (34.3%, 95%§Ґ§Є 28.3-40.2%), §С §У §Ф§в§е§б§б§Ц §б§Э§С§и§Ц§Т§а - 78 (31.5%, 95%§Ґ§Є 25.6-37.3%, §в=0.51). §Ї§Ц §Т§н§Э§а §в§С§Щ§Э§Ъ§й§Ъ§Ы §У §Э§Ц§д§С§Э§о§Я§а§г§д§Ъ §Ъ §У §Х§в§е§Ф§Ъ§Ц §У§в§Ц§Ю§Ц§Я§Я§н§Ц §б§Ц§в§Ъ§а§Х§н.
§Ј§д§а§в§Ъ§й§Я§н§Ы §С§Я§С§Э§Ъ§Щ (post hoc) §б§а§Ь§С§Щ§С§Э, §й§д§а §У §б§а§Х§Ф§в§е§б§б§Ц §б§С§и§Ъ§Ц§Я§д§а§У §г §г§Ъ§г§д§а§Э§Ъ§й§Ц§г§Ь§Ъ§Ю §Ў§Ґ<90 §Ю§Ю §в§д §г§д §У §б§Ц§в§У§н§Ц 30 §й§С§г§а§У §а§д §Я§С§й§С§Э§С §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§с §е§Ю§Ц§в§Э§а 31/69 §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С (44.9%) §Ъ 32/57(56.1%) ЁC §б§Э§С§и§Ц§Т§а, §в§С§Щ§Я§Ъ§и§С ЁC11.2% (95%§Ґ§Є ЁC18.6%-6.2%, §в=0.28). §і§в§Ц§Х§Ъ §д§Ц§з, §е §Ь§а§Ф§а §Ў§Ґ>90§Ю§Ю §в§д §г§д §е§Ю§Ц§в§Э§а §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а 55/181 (30.4%) §Ъ 46/189 (24.3%), §в§С§Щ§Я§Ъ§и§С 6.1% (95%§Ґ§Є ЁC3.0-15.1%, §в=0.20). §Ї§Ц §в§С§Щ§Э§Ъ§й§С§Э§С§г§о §Ъ §Э§Ц§д§С§Э§о§Я§а§г§д§о §У §б§Ц§в§У§н§Ц §Х§У§а§Ц §г§е§д§а§Ь §г§в§Ц§Х§Ъ §Т§а§Э§о§Я§н§з, §б§а§Э§е§й§Ъ§У§к§Ъ§з §Ъ§г§г§Э§Ц§Х§е§Ц§Ю§н§Ц §б§в§Ц§б§С§в§С§д§н §У §б§Ц§в§У§н§Ц 12§й: §е§Ю§Ц§в§Э§а 73/198 (36.9%) - §Я§С §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§Ц §Ъ 58/186(31.2%) - §Я§С §б§Э§С§и§Ц§Т§а, §в=0.28.28 §Х§Я§Ц§У§Я§С§с §Э§Ц§д§С§Э§о§Я§а§г§д§о §Т§н§Э§С §У§н§к§Ц §г§в§Ц§Х§Ъ §б§а§Э§е§й§Ъ§У§к§Ъ§з §п§д§а§Ю§Ъ§Х§С§д §Х§а §Я§С§й§С§Э§С §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§с: 23/51 (45.1%) §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С §Ъ 18/45 (40.0%) - §б§Э§С§и§Ц§Т§а. §і§в§Ц§Х§Ъ §Я§Ц §б§а§Э§е§й§Ъ§У§к§Ъ§з §б§в§Ц§б§С§в§С§д §п§д§Ъ §и§Ъ§ж§в§н §г§а§г§д§С§У§Ъ§Э§Ъ §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а 63/200 (31.5%) §Ъ 60/203 (29.6%), §в=0.03.
§Ј §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С §Т§а§Э§о§Я§н§Ц §Т§н§г§д§в§Ц§Ц §У§н§з§а§Х§Ъ§Э§Ъ §Ъ§Щ §к§а§Ь§С: §Ю§Ц§Х§Ъ§С§Я§С §У§в§Ц§Ю§Ц§Я§Ъ 3.3 §Х§Я§с (95%§Ґ§Є 2.9-3.9) §б§в§а§д§Ъ§У 5.8 §Х§Я§Ц§Ы (95%§Ґ§Є 5.2-6.9), §в<0.001; §г§в§Ц§Х§Ъ §а§д§У§Ц§д§Ъ§У§к§Ъ§з §Я§С §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я - 2.8 §Х§Я§с (95%§Ґ§Є 2.1-3.3) §б§в§а§д§Ъ§У 5.8 §Х§Я§Ц§Ы (95%§Ґ§Є 5.2-6.9) p<0.001; §г§в§Ц§Х§Ъ §Я§Ц §а§д§У§Ц§д§Ъ§У§к§Ъ§з - §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а 3.9 (95%§Ґ§Є 3.0-5.2) §б§в§а§д§Ъ§У 6.0 (95%§Ґ§Є 4.9-9.0)§в=0.06. §±§в§а§и§Ц§Я§д §п§Ь§г§д§е§Т§Ъ§в§а§У§С§Я§Я§н§з §Ь 28 §Х§Я§р §У §Ф§в§е§б§б§С§з §Я§Ц §в§С§Щ§Э§Ъ§й§С§Э§г§с: §г§в§Ц§Х§Ъ §Ъ§Я§д§е§Т§Ъ§в§а§У§С§Я§Я§н§з §Х§а §в§С§Я§Х§а§Ю§Ъ§Щ§С§и§Ъ§Ъ §а§д§Э§е§й§Ц§Я§н §а§д §Є§Ј§ 119/228 §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С (52%) §Ъ 113/212 (53%) §У §Ф§в§е§б§б§Ц §б§Э§С§и§Ц§Т§а.
§µ 357 §Т§а§Э§о§Я§н§з §Т§н§Э §Ъ§Щ§а§Э§Ъ§в§а§У§С§Я §У§а§Щ§Т§е§Х§Ъ§д§Ц§Э§о §Ъ§Я§ж§Ц§Ь§и§Ъ§Ъ§Ъ. §Ў§Х§Ц§Ь§У§С§д§Я§е§р §С§Я§д§Ъ§Ю§Ъ§Ь§в§а§Т§Я§е§р §д§Ц§в§С§б§Ъ§р §б§а§Э§е§й§С§Э§Ъ 126/173 (72.
§Ј§н§У§а§Х§н.
§±§а §в§Ц§Щ§е§Э§о§д§С§д§С§Ю §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§с §Я§Ъ§Щ§Ь§а§Х§а§Щ§а§У§н§Ы §У/§У §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я §Я§Ц §е§Э§е§й§к§С§Э §У§н§Ш§Ъ§У§С§Ц§Ю§а§г§д§о §Т§а§Э§о§Я§н§з §г §г§Ц§б§д§Ъ§й§Ц§г§Ь§Ъ§Ю §к§а§Ь§а§Ю §Я§Ц§Щ§С§У§Ъ§г§Ъ§Ю§а §а§д §д§а§Ф§а, §в§Ц§С§Ф§Ъ§в§а§У§С§Э §Т§а§Э§о§Я§а§Ы §Я§С §г§д§Ъ§Ю§е§Э§с§и§Ъ§р §Ь§а§в§д§Ъ§Ь§а§д§в§а§б§Ъ§Я§а§Ю §Ъ§Э§Ъ §Я§Ц§д. §°§Х§Я§С§Ь§а §У §Ф§в§е§б§б§Ц §Ф§Ъ§Х§в§а§Ь§а§в§д§Ъ§Щ§а§Я§С §е §Т§а§Э§о§Я§н§з §Т§н§г§д§в§Ц§Ц §У§а§г§г§д§С§Я§С§У§Э§Ъ§У§С§Э§Ъ§г§о §б§а§Ь§С§Щ§С§д§Ц§Э§Ъ §Ф§Ц§Ю§а§Х§Ъ§Я§С§Ю§Ъ§Ь§Ъ. §Ј §г§а§б§е§д§г§д§У§е§р§л§Ц§Ы §в§Ц§Х§С§Ь§и§Ъ§а§Я§Я§а§Ы §г§д§С§д§о§Ц Simon Fifer §Ъ§Щ §е§Я§Ъ§У§Ц§в§г§Ъ§д§Ц§д§С §Ф. §і§Ъ§Х§Я§Ц§с (§Ў§У§г§д§в§С§Э§Ъ§с) §а§д§Ю§Ц§й§С§Ц§д §Ю§Ц§д§а§Х§а§Э§а§Ф§Ъ§й§Ц§г§Ь§Ъ§Ц §д§в§е§Х§Я§а§г§д§Ъ §б§в§а§У§Ц§Х§Ц§Я§Ъ§с §д§С§Ь§Ъ§з §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§Ы. §Ґ§С§Ш§Ц CORTICUS, §Ь§в§е§б§Я§Ц§Ы§к§Ц§Ц §Ъ§г§б§н§д§С§Я§Ъ§Ц §У §п§д§а§Ю §в§а§Х§Ц, §а§Ь§С§Щ§С§Э§а§г§о §Я§Ц§Х§а§г§д§С§д§а§й§Я§а §Ю§а§л§Я§н§Ю. §°§Я §б§а§Х§й§Ч§в§Ь§Ъ§У§С§Ц§д, §й§д§а §Ь§Э§Ъ§Я§Ъ§и§Ъ§г§д§н, §Я§С§Щ§Я§С§й§С§р§л§Ъ§Ц §Ь§а§в§д§Ъ§Ь§а§г§д§Ц§в§а§Ъ§Х§н §б§в§Ъ §к§а§Ь§Ц §Х§а§Э§Ш§Я§н §а§г§а§Щ§Я§а§У§С§д§о, §й§д§а §Т§н§г§д§в§а§Ц §У§а§г§г§д§С§Я§а§У§Э§Ц§Я§Ъ§Ц §Ф§Ц§Ю§а§Х§Ъ§Я§С§Ю§Ъ§Ь§Ъ §У§а§У§г§Ц §Я§Ц §а§Щ§Я§С§й§С§Ц§д §Э§е§й§к§Ц§Ц §У§н§Ш§Ъ§У§С§Я§Ъ§Ц §б§С§и§Ъ§Ц§Я§д§а§У.
Sprung et al. Hydrocortisone Therapy for Patients with Septic Shock. N Engl J Med. Jan. 10, 2008;358:111-24. §і§д§С§д§о§с-§Ъ§г§д§а§й§Я§Ъ§Ь. Medline §С§Т§г§д§в§С§Ь§д.
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