免疫球蛋白预防创伤患者机械通气相关性肺炎的实验研究

Prevention of Ventilator-associated Pneumonia in Trauma Patients by Intravenous Immunoglobulins

目的 了解静脉应用免疫球蛋白对创伤患者机械通气相关性肺炎的发生率的影响。方法 选择 37例严重创伤后机械通气患者 ,分为静脉应用免疫球蛋白组 (IVIG)和对照组 (输注人血白蛋白 ) ;在 1、4、7d取血标本作血清杀菌活性 (SBA )分析 ,同时定量分析 Ig G,测量补体 C3;记录每个患者在 ICU住院时间、感染相关的死亡率及分离培养的病菌、第 4天以后使用抗生素的时间。结果 IVIG与对照组比较 ,机械通气相关肺部感染发生率明显降低 (P <0 .0 5 ) ;抗生素使用天数及入住 ICU天数前者比后者短 ,但差异无统计学意义 ;IVIG组 Ig G明显增加 ,而对照组无明显差别 ,C3在两组间差异无显著性 ;SBA分析 :两组间比较 ,37℃下孵化 30 min及 12 0 m in,SBA第 1天差异均无显著性 ,在第 4天及第 7天均相差显著 ;组内比较 ,每组患者第 1天与第 4天比较 ,SBA在30 min和 12 0 m in,对照组差异无显著性 ,而实验组差异均有非常显著性。结论 静脉应用免疫球蛋白能提高血清杀菌活性 ,降低机械通气相关性肺炎的发生率 ,血清杀菌活性可作为创伤患者对感染易感性的一个敏感指标。

OBJECTIVETo investigate the activity of intravenous immunoglobulins (IVIG) as prophylactic agents against ventilator-associated pneumonia in trauma patients. METHODSA total of 37 trauma patients in status of ventilating were randomly divided into two groups: IVIG group and control group (received human albumin). Blood was collected on days 1, 4, 7, serum bactericidal activity (SBA) was assessed, IgG and C3 were measured. Clinical variables related to infection were recorded. RESULTSCompared with control group, IVIG group had fewer ventilator-associated pneumonia (P<0.05). Length of stay in ICU, antibiotic days and infection-related mortality showed no difference between two groups. A significantly increased trend in IgG was shown in IVIG group but not in control one. No differences were noted in C3. The SBA of the groups was similar on day 1,but significantly higher on days 4 and 7 in IVIG group; compared SBA on day 4 with day 1, IVIG group increased significantly, but no change in control one. CONCLUSIONS IVIG cold improve the SBA and has on affection on prevention of ventilator-associated pneumonia in trauma patients. Early SBA measurement may represent an index of susceptibility of infection.