What are the roles of corticosteroids in shock?

When corticosteroids are used in shock, their main effects include anti-inflammatory action, enhancing the body's anti-shock capacity, stabilizing lysosomal membranes, improving microcirculation, and suppressing excessive immune activation. A detailed analysis is as follows:

1. Anti-inflammatory effect: Corticosteroids inhibit the release of inflammatory mediators, reduce vasodilation and increased vascular permeability, decrease inflammatory exudation, and alleviate tissue edema. They also suppress excessive leukocyte aggregation and phagocytic activity, preventing amplification of the inflammatory response and creating a favorable environment for recovery.

2. Enhanced anti-shock capacity: Corticosteroids increase vascular responsiveness to vasoconstrictive substances, helping maintain vascular tone and improve blood pressure. They also promote glycogenolysis and gluconeogenesis in the liver, increasing glucose availability to provide energy for vital organs and enhancing the body’s tolerance to shock.

3. Stabilization of lysosomal membranes: In shock, lysosomes are prone to rupture and release hydrolytic enzymes that damage surrounding tissues. Corticosteroids stabilize the structure of lysosomal membranes, prevent enzyme release, minimize cellular and tissue damage, and protect organ function from further deterioration.

4. Improvement of microcirculation: Corticosteroids reduce endothelial injury, lower microvascular resistance, and enhance tissue perfusion. By regulating blood flow distribution in the microcirculation, they direct more blood to critical organs such as the heart, brain, and kidneys, thereby alleviating tissue hypoxia and ischemia.

5. Suppression of excessive immune activation: In conditions like septic shock, excessive immune activation can trigger a cytokine storm. Corticosteroids suppress immune cell activity and reduce excessive secretion of cytokines, preventing secondary damage caused by an overactive immune response.

The appropriate use of corticosteroids requires consideration of the type of shock and the individual patient’s condition. Dosage and duration of treatment should be precisely managed by qualified physicians to ensure therapeutic efficacy and minimize the risk of adverse effects.