免疫调理治疗对创伤性严重脓毒症和多器官功能障碍综合征的临床研究  

Clinical research of immune conditioning treatment of traumatic severe sepsis with multiple organ dysfunction syndromes

作　　者：李文[1] 王丹心[1] 余壮明[1] 

机构地区：[1]海南医学院第一附属医院,海南海口570102

出　　处：《中国急救医学》2017年第9期786-789,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 观察免疫调理治疗对创伤性严重脓毒症和多器官功能障碍综合征（MODS）的临床疗效。方法 将2014-01～2016-07我院收治的86例创伤性严重脓毒症合并MODS患者随机分为2组（43例/组），对照组给予抗炎、抑菌、补液、预防应激性溃疡等支持治疗及连续性血液净化治疗，观察组患者在对照组治疗的基础上给予免疫调理治疗。治疗3周后，观察两组的腹痛、腹胀、肠鸣音、排便等临床症状，比较凝血酶原时间（PT） 、凝血酶时间（TT） 、活化部分凝血活酶时间（APTT）等凝血指标，血清白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）等炎症因子水平，CD4^＋、CD8^＋和CD14^＋T 淋巴细胞亚群比例，6个月后的APACHEⅡ评分、MODS评分和病死率。结果 观察组腹胀、腹痛例数显著低于对照组，而肠鸣音和排便次数高于对照组（P〈0.05）。观察组PT、TT、APTT显著低于对照组（P〈0.05）。观察组血清TNF-α、IL-6、IL-10水平显著低于对照组（P〈0.05）。观察组CD4^＋和CD14^＋ T 淋巴细胞亚群比例显著高于对照组，而CD8^＋显著低于对照组（P〈0.05）。治疗6个月后，观察组患者的APACHEⅡ评分、MODS评分和病死率均显著低于对照组（P〈0.05）。结论 免疫调理治疗可显著改善创伤性严重脓毒症合并MODS患者的临床症状，减轻炎症反应，改善凝血功能，调节免疫功能，具有较好的远期临床疗效。Objective To observe the curative effect of immune conditioning treatment of traumatic severe sepsis with multiple organ dysfunction syndromes （MODS）. Methods 86 patients with traumatic severe sepsis and MODS from January 2014 and July 2014 in our hospital were divided into two groups （43 cases in each group）. The control group was given anti - inflammatory, antibacterial, rehydration, prevention of stress ulcer and continuous blood purification treatment, the observation group patients were treated in immune conditioning treatment on the basis of the control group. After 3 weeks treatment, the abdominal pain, abdominal distention, bowel movements, such as clinical symptoms, bowel sounds in two groups were observed, and the coagulation index of prothrombin time （PT） , thrombin time （TT）, activated partial thrombin time （APTT）, the serum inflammatory factor levels of interleukin - 6 （ IL - 6 ） and interleukin - 10 （ IL - 10）, tumor necrosis factor alpha （ TNF -α）, and T lymphocyte subgroup percentage of CD4^ ＋ , CD8 ^＋ and CD14 ^＋ were compared. After six months, the APACHE Ⅱ grade, MODS and mortality were observed. Results The cases of abdominal distension and abdominal pain in observation group were lower than control group, and bowel sounds and defecation frequency were higher than the control group （ P 〈 0.05 ）. The PT, TT and APTT in the observation group were lower than the control group （ P 〈 0.05 ）. The serum levels of TNF - or, IL - 6, and IL - 10 in the observation group were lower than the control group （ P 〈 0. 05 ）. The lymphocyte subgroup percentage of CD4 ^＋ and CD14 ^＋ were higher than the control group, the CD8^＋ was lower than the control group （ P 〈 0.05 ）. After six months, the APACHE Ⅱ grade, MODS and mortality in observation group were lower than control group （P 〈 0. 05 ）. Conclusion The immune conditioning treatment of traumatic severe sepsis with multiple organ dysfunction syndromes can significantly improve the

关 键 词：免疫调理 脓毒症 多器官功能障碍综合征(MODS) 血流动力学 炎症反应 免疫功能 

分 类 号：R59[医药卫生—内科学]