胸腺肽-α1对机械通气患者早期VAP的防治研究  

Prevention Effect of Thymosin-α1 Aganist Early Ventilator-associated Pneumonia in Patients with Mechanical Ventilation

作　　者：张松松[1] 李琨[1] 王宇辉[1] 叶八宁[1] 潘渝[1] 施贤清[1] 

机构地区：[1]贵州省人民医院重症医学科,贵阳550002

出　　处：《四川大学学报（医学版）》2015年第6期957-959,共3页Journal of Sichuan University(Medical Sciences)

基　　金：贵州省社会公关项目基金(黔科合SY[2011]3032号)资助

摘　　要：目的观察胸腺肽-ɑ1对机械通气患者免疫功能的影响及对早期呼吸机相关性肺炎(VAP)的预防效果。方法 52例行机械通气(时程预计超过48h)的患者随机分为常规治疗组(n=26)和胸腺肽组(n=26),常规治疗组予重症监护室(ICU)常规治疗,胸腺肽组在常规治疗基础上加用胸腺肽-ɑ1(1.6mg皮下注射,1次/d×7d)治疗;测定机械通气前和机械通气3d及7d两组患者血中的T淋巴细胞亚群、CD14+单核细胞人类白细胞抗原-DR(CD14+HLA-DR)、血清降钙素原(PCT)的变化,观察两组患者VAP发生率、VAP发生时间、机械通气时程及ICU住院时间。结果机械通气前两组患者基础状况及免疫指标差异无统计学意义(P>0.05);胸腺肽组在机械通气第3d和7dCD3+、CD4+、CD4+/CD8+、CD14+HLA-DR较同组机械通气前及同时点常规治疗组升高,血清PCT水平较同时点常规治疗组下降,差异均有统计学意义(P<0.05);胸腺肽组VAP发病率比常规治疗组低,但两组间差异无统计学意义(P>0.05);胸腺肽组VAP发病时间较常规治疗组晚,机械通气时间及ICU住院时间较常规治疗组缩短,差异均有统计学意义(P<0.05)。结论胸腺肽-α1能改善机械通气患者的免疫状况,对早期VAP的防治具有一定作用。Objective To investigate the preventive effects of thymosin-α1against early ventilator-associated pneumonia（VAP）in the patients with mechanical ventilation.Methods Fifty two patients with expectancy of mechanical ventilation over 48 hwere divided into routine therapy group（n=26）and thymosin therapy group（n=26）in random.The patients in routine therapy group were given intensive care unit（ICU）conventional treatment,and the patients in thymosin therapy group were given thymosin treatment additionally（1.6 mg subcutaneous injection,qd×7 d）.The incidence and occurrence time of VAP were observed,and the time of mechanical ventilation and ICU stay were recorded.The levels of CD3＋,CD4＋,CD4＋/CD8＋T lymphocyte,CD14＋mononuclear cell human leukocyte antigens-DR（CD14＋HLA-DR）and procalcitonin（PCT）were detected before mechanical ventilation and at the 3rd and 7th d after mechanical ventilation.Results The base line including the level of immunologic function had no difference between the two groups（P〉0.05）.The incidence of VAP in thymosin therapy group was lower than that in routine therapy group,but it was not significant difference（P〈0.05）.The durations of machine ventilation and ICU stay in thymosin therapy group were shorter than those in routine therapy group（P〈0.05）.The occurrence time of VAP in thymosin therapy group was significantly later than that in routine therapy group（P〈0.05）.At the 3rd and 7th d after mechanical ventilation,thymosin therapy group achived higher levels of CD3＋,CD4＋,CD4＋/CD8＋T lymphocyte and CD14＋HLA-DR than routine therapy group did（P〈0.05）.Conclusion Thymosin-α1 may be able to improve immunologic function and prevent the incidence of early VAP in the patients with mechanical ventilation.

关 键 词：机械通气 胸腺肽-Α1 VAP 

分 类 号：R563.1[医药卫生—呼吸系统]