免疫球蛋白在长期机械通气老年患者肺部感染治疗中的辅助作用

Effects of intravenous immunoglobulin in therapy for the elderly patients with pulmonary infection receiving long-term mechanical ventilation

目的探讨静脉注射大剂量免疫球蛋白在老年长期机械通气患者肺部感染治疗中的辅助作用。方法长期机械通气后并发肺部感染的老年患者46例,随机分成对照组(22例)和试验组(24例),对照组予以常规针对病原体的治疗,试验组在常规治疗基础上辅以静脉注射大剂量免疫球蛋白[100～250mg/(kg·d)],连续使用3～7d。观察各组临床有效率、重症肺部感染发生率、病死率和肺部感染再发情况。检测2组治疗前后血清免疫指标(CD4、CD8、CD4/CD8)的变化。结果试验组和对照组临床有效率分别为91.67%和45.45%,发生重症肺部感染率为8.33%和40.90%,病死率为0和13.64%,肺部感染再发率为0和13.64%,其差异均有统计学意义(P<0.01)。试验组CD4、CD8、CD4/CD8较治疗前明显改善(P<0.01),且明显优于对照组治疗后水平(P<0.01)。结论联合静脉注射大剂量免疫球蛋白作为一种辅助治疗,能有效阻止呼吸机相关性肺炎进一步发展,降低重症肺部感染的发生率和病死率。

Objective To evaluate the adjunctive therapeutic effect of intravenous immunoglobulin （IVIG） in therapy for elderly patients with pulmonary infection receiving long-term mechanical ventilation. Methods Forty-six patients with pulmonary infection receiving long-term mechanical ventilation were randomly divided into control group （22 cases） and experiment group （24 cases）. The patients in experiment group, on the basis of routine treatment, were treated with high dose of IVIG therapy. The improvement rate, the incidence and mortality of severe pulmonary infection, levels of serum CD4, CD8, CD4/CD8 among the two groups were observed. Results The improvement rate was 91.67% and 45.45% in experiment group and control group respectively, and the incidence of severe pulmonary infection was 8.33% and 40. 90%respectively with the mortality being 0 and 13.64%. The levels of serum CD4,CD8,CD4/CD8 were significantly improved in experiment group after treatment as compared with that before treatment and in control group （P〈0.01）. Conclusions As an adjunctive therapy, high dose of IVIG at early stage of pulmonary infection can reduce the incidence of severe pulmonary infection and mortality after receiving lone-term mechanical ventilation.