连续性血液净化对严重创伤患者免疫功能的影响  

Effects of Continuous Blood Purification on Immune System of Patients with Severe Trauma

作　　者：曾晖[1] 阮少川[1] 覃炳军[1] 江东新[1] 温步优[1] 

机构地区：[1]东莞市人民医院ICU,广东东莞523018

出　　处：《实用临床医学（江西）》2006年第12期77-79,82,共4页Practical Clinical Medicine

基　　金：广东省医学科学技术研究基金项目(编号:WSTJJ20020108450202194412040013)

摘　　要：目的探讨早期连续性血液净化(CBP)治疗对严重创伤患者免疫功能的影响和治疗意义。方法40例严重创伤患者,其中22例在发病24h内行CBP治疗设为治疗组,其余18例未行CBP治疗设为对照组,动态检测并比较CBP治疗10d内两组患者血免疫球蛋白(IgG、IGM、IgA)、补体(C3、C4)和白介素2(IL-2)水平的变化,同时对两组患者的临床病情转归进行APACHEⅡ评分。结果两组患者血免疫球蛋白和补体水平均明显下降,治疗组在CBP治疗的第3天IgG、IgM、IgA和C3水平基本恢复正常,而对照组IgG、IgM、IgA和C3仍维持较低水平,至第10天才逐渐上升(P<0.01);两组患者IL-2水平均低于正常,但治疗组在CBP治疗后第3天即逐渐上升,但对照组仍保持较低水平,至第7天才逐渐上升(P<0.05);治疗组在CBP治疗后APACHEⅡ评分下降明显(P<0.01),感染发生率、脏器功能衰竭发生率较对照组低(P<0.01)。结论严重创伤患者早期处于免疫抑制状态,CBP治疗可改善患者的免疫抑制,减少感染发生率和多脏器功能衰竭的发生。Objective： To investigate the effects of continuous blood purification on immune system of patients with severe trauma and its therapeutic significance. Methods： Forty patients with severe trauma were divided into two groups： treatment group （22 cases receiving CBP therapy within 24 hours after trauma） and control group （18 cases without CBP treatment ）. The serum concentrations of IgG, IgM, IgA, C3, C4 and IL-2 from all patients were determined continuously on the 1^nt 3^rd, 5^th, Th and 10^th day. At the same time the clinical manifestation changes and APACH scores were recorded. Results： The serum concentrations of IgG, IgM, IgA, C3, C4 and IL-2 decreased significantly in all patients with severe trauma on the first day. With CBP treatment the levels of IL-2, IgG, IgA and C3 increased gradually in 24 hours after starting CBP, and the level of IgM began to increase in 48 hours after CBP. For those without CBP treatment the levels of igG, IgM, IgA, C3,C4 and IL-2 remained to be low during the previous 7 days. The clinical manifestations for those CBP treated patients improved prominently and the APACH Ⅱ scores declined very significantly. The morbidity and mortality of severe infections, MODS for the CBP treatment group also were lower obviously than those in control group. Conclusion： The patients with severe trauma stayed in immune suppression state during the early stage. CBP treatment could help to ameliorate the immune function and consequently and improve the prognosis.

关 键 词：连续性血液净化 严重创伤 代偿性抗炎症反应综合征 

分 类 号：R641[医药卫生—外科学]