免疫调节剂辅助治疗长期机械通气老年患者肺部感染的研究

Adjunctive Therapy of Immunoregulators for Pulmonary Infection in Old Male Patients Subjected to Mechanical Ventilation

目的探讨免疫调节剂在长期机械通气老年患者肺部感染治疗中的辅助作用。方法将机械通气后的老年患者分成试验组和对照组。试验组再分别应用胸腺肽α1(A组),免疫球蛋白(B组),泛福舒(C组),当感染时加用常规针对病原体的治疗。对照组感染时仅常规针对病原体的治疗。观察各组肺部感染发生次数、持续时间、重症肺部感染发生率,检测各组治疗前后血清免疫指标的变化。结果治疗组分别与对照组相比,肺部感染发生次数、持续时间、重症肺部感染发生率均减少(P<0.01),各治疗组CD4升高,CD8下降,CD4/CD8比例升高,较治疗前明显改善(P<0.01),且明显优于对照组(P<0.01),治疗组间比较无明显差异(P>0.05)。未出现明显不良反应。结论老年患者长期机械通气肺部感染,应用免疫调节剂治疗是安全且有明显辅助疗效的。

Objective To evaluate the assistant effect of immunoregulators on pulmonary infection in old patients after long-term mechanical ventilation. Methods Ninety old male patients subjected to mechanical ventilation due to respiratory failure were divided into trial group and control group. Routine anti-pathogen therapy was adopted in all the patients when pulmonary infection was complicated. In the control group （n = 22）, no immunoregulators were used. The trial group was divided into three subgroups： group A （n： immunoglobulin, group C （n = 22） with Broncho Vaxom, 23） was treated with thymosin alpha1, group B （n = 23） with respectively. The incidence, duration of pulmonary infection and the incidence of severe pulmonary infection were observed, and serum levels of immunological parameters were detected before and after treatment in all the groups. Results The incidence of pulmonary infection and severe pulmonary infection was lower in the trial groups, and the duration was shorter than that of the control group （P〈0.01）. In the trial groups, the level of CD4 was elevated and the level of CD8 was declined, therefore the CD4/CD8 ratio was elevated after treatment （P〈0. 01 ）. The levels of CD4 and CD8 and the CD4/CD8 ratio in the trial groups were significantly different with those in the control group （P〈0. 01 ）, but showed no difference between any two trial groups （P〉0. 05）. No severe side-effect was observed in all the trial groups. Conclusion Its safe and effective to use immunoregulators in old patients with pulmonary infection after long-term mechanical ventilation.