PICCO指导下液体复苏对脓毒症休克患者免疫功能及炎症介质的影响  

Effects of fluid resuscitation under the guidance of PICCO on the immune function and inflammatory mediator in patients with septic shock

作　　者：卢露[1] 潘国权[1] 汤鲁明[2] 王林霞[1] 王志翊[2] 潘小东[2] 孙来芳[2] 

机构地区：[1]温州医科大学附属第二医院、育英儿童医院儿童ICU,浙江温州325000 [2]温州医科大学附属第二医院、育英儿童医院急诊ICU,浙江温州325000

出　　处：《中华全科医学》2017年第4期562-564,共3页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2013RCA039)

摘　　要：目的探讨在脓毒症休克早期不同的液体复苏方法对患者免疫功能、炎症反应及脏器功能的影响。方法选择2012年11月—2015年11月温州医科大学附属第二医院ICU收治的成人脓毒症休克患者180例,按数字随机法分为脉搏指示连续心排出量(pulse indicator continuous cardiac output,PICCO)组94例和常规组86例,PICCO组患者在PICCO技术监测下进行精准的液体复苏,而常规组以常规方法进行液体复苏。对比分析2组患者在复苏后脏器功能变化;ET-1、乳酸、白介素-10等炎症因子的变化;T淋巴细胞等免疫功能变化,以及microRNA-155等分子生物学指标的变化情况。结果 2组患者入院时的性别、年龄、急性生理学慢性健康状况评分(APACHEⅡ)、平均动脉压、休克状态差异均无统计学意义(P>0.05),具有可比性。经不同方法液体复苏后,PICCO组患者的血压波动幅度、BNP、IL-10、ET-1水平低于常规组患者(P<0.05),差异有统计学意义;PICCO组患者的microRNA-155、T细胞亚群高于常规组患者(P<0.01)。结论 PICCO指导下的液体复苏不但能使血压平稳恢复,减轻心脏负荷,同时减轻炎症介质,对提高免疫功能具有一定的作用。Objective To investigate effects of fluid resuscitation under the guidance of pulse indicator continuous cardiac output（ PICCO） on the immune function,inflammatory mediator and organ function in patients with septic shock.Methods Total 180 patients suffering from septic shock in ICU of our hospital from 2012 to 2015 were enrolled and divided into PICCO group（ n = 94） and conventional group（ n = 86）. The fluid resuscitation procedure was performed in the PICCO group guided by PICCO for adjusting really time the hemodynamic parameters,and in the control evaluated by central venous pressure and vital signs. The vital signs,the level of ET-1,lactate and IL-10,T cells and microRNA-155 were compared between the two groups. Results There were no significant difference between the two groups in sex,age,APACHE Ⅱ scores,mean arterial pressure and state of shock（ P〉0. 05）. After the fluid resuscitation,the blood pressure fluctuations,levels of BNP,IL-10 and ET-1 of PICCO group were significantly lower than that in the conventional group（ P〈0. 05）. The microRNA-155 and T cells of PICCO group were significantly higher than those in the conventional group（ P〈0. 05）. Conclusion The liquid recovery under the guidance of PICCO can make blood pressure recovery smoothly,reduce cardiac load,decrease inflammation medium and improve immune function.

关 键 词：脓毒性休克 T淋巴细胞亚群 微小RNA-155 内皮素-1 

分 类 号：R631.4[医药卫生—外科学]