不同目标血压对老年脓毒症休克患者血清炎症因子及免疫功能影响  

Effects of different target blood pressure on serum inflammatory factors and immune function in elderly patients with septic shock

作　　者：朱良峰[1] 陈春霞[2] 陈万[1] 吕立文[1] 唐宇涛[1] ZHU Liang-feng;CHEN Chun-xia;CHEN Wan;LYU Li-wen;TANG Yu-tao(Department of Emergency,The Guangxi Zhuang Autonomous Region People′s Hospital,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院急诊科,广西南宁530021 [2]广西壮族自治区人民医院科研部,广西南宁530021

出　　处：《创伤与急危重病医学》2020年第1期21-24,共4页Trauma and Critical Care Medicine

基　　金：广西科技攻关计划项目(桂科攻15277007);广西卫生健康委计划项目(Z2016618);广西卫生健康委计划项目(Z20170356)

摘　　要：目的探讨高、低目标血压对老年脓毒症休克患者炎症因子及免疫功能的影响。方法选取自2017年1—12月广西壮族自治区人民医院收治的92例老年脓毒症休克患者为研究对象,根据脓毒症休克集束治疗目标血压将患者按随机数表法分为低目标血压组(n=44)与高目标血压组(n=48)。目标血压以桡动脉有创血压监测平均动脉压为指导,低目标血压组平均动脉压控制在65~70 mmHg,高目标血压组平均动脉压控制在80~85 mmHg。比较两组治疗前、后急性生理与慢性健康评分Ⅱ(APACHEⅡ)、多器官功能障碍综合征(MODS)病情严重度评分及预后评估系统评分、全身性感染相关性器官功能衰竭评分(SOFA)、血清炎症因子水平,以及免疫功能指标变化情况。结果治疗5 d后,两组患者APACHEⅡ评分、MODS病情严重度评分及预后评估系统评分、SOFA评分均较治疗前显著降低,且高目标血压组低于低目标血压组,差异有统计学意义(P<0.05)。治疗5 d后,两组患者白细胞介素(IL)-6、IL-8、降钙素原(PCT)水平均较治疗前显著降低,且高目标血压组低于低目标血压组,差异有统计学意义(P<0.05)。治疗5 d后,两组患者CD3+、CD4+细胞水平较治疗前显著升高,且高目标血压组高于低目标血压组,差异有统计学意义(P<0.05)。治疗5 d后,两组患者自然杀伤细胞(NK)较治疗前显著降低,且高目标血压组低于低目标血压组,差异有统计学意义(P<0.05)。结论脓毒症休克集束治疗高目标血压有助于改善老年患者机体血流,缓解全身炎症反应,提高机体免疫功能。Objective To investigate the effect of high/low target blood pressure on serum inflammatory factors and immune function in elderly patients with septic shock.Methods A retrospective study was performed on 92 cases of elderly patients with septic shock who were admitted from January to December 2017.According to the target blood pressure of septic shock cluster therapy,the patients were randomly divided into the low target blood pressure group(n=44)and the high target blood pressure group(n=48).The target blood pressure was guided by the mean arterial pressure of invasive blood pressure monitoring of the radial artery.The mean arterial pressure of the low target blood pressure group was controlled at 65~70 mmHg,and that of the high target blood pressure group was controlled at 80~85 mmHg.Comparing the two groups before and after treatment of acute physiology and chronic health status scoresⅡ(APACHEⅡ),multiple organ dysfunction syndrome(MODS)illness severity score and prognosis assessment system evaluation,systemic infection related organ function failure(SOFA),serum levels of inflammatory cytokines and index changes in immune function.Results The 5 days after treatment,two groups of patients with APACHE Ⅱ score,MODS illness severity score grading and prognosis assessment system,SOFA score was significantly reduced,and the low and high blood pressure target group is lower than the target blood pressure group,and the difference was statistically significant(P<0.05).After 5 days of treatment,the levels of interleukin(IL)-6,IL-8 and procalcitonin(PCT)in the two groups were significantly lower than those before treatment(P<0.05).After 5 days of treatment,the levels of CD3+and CD4+cells in the two groups were significantly higher than those before treatment,and the high target blood pressure group was higher than the low target blood pressure group(P<0.05).After 5 days of treatment,natural killer cells(NK)in the two groups were significantly lower than before treatment,and the high target blood pressure group was

关 键 词：结直肠肿瘤 术后肠梗阻 原因 对策血压 脓毒症休克 炎症因子 免疫功能 

分 类 号：R459.7[医药卫生—急诊医学]