严重创伤患者免疫功能抑制的影响因素

Influence factors of immunosuppression in severe trauma patients

目的分析严重创伤患者免疫功能持续抑制的影响因素。方法 ICU收治的严重创伤患者104例,创伤严重度评分(ISS)>25分。其中,一过性免疫功能抑制组62例,单核细胞人白细胞抗原DR(mHLA-DR)在1周内表达率能恢复到80%以上,持续性免疫功能抑制组42例,1周内mHLA-DR表达率的恢复<80%。对患者的临床资料分别进行Logistic单因素和多因素回归分析。结果持续性免疫功能抑制发生率40%。Logistic多因素分析示:ISS(OR=2.41,P<0.05)、入院24-h血乳酸值(OR=1.14,P<0.05)、入院24h内大量输血(OR=3.22,P<0.01)和入院72h内输血量(OR=2.41,P<0.05)是mHLA-DR持续低表达的独立危险因素;而早期肠内营养(OR=0.21,P<0.01)是mHLA-DR恢复的有利因素。结论严重创伤、休克、早期大量输血和反复输血是严重创伤患者免疫功能持续抑制的独立危险因素,早期肠内营养能促进免疫功能的恢复。

Objective To analyze the influence factors of persistant immunosuppression in severe trauma patients. Methods On the basis of whether the decreased expression of monocyte human leukocyte antigen-DR（mHLA-DR） can restore to more than 80% in a week, 104 patients with severe trauma （ISS 〉 25 points） in ICU was assigned into two groups of A （transient immunosuppression, 62 cases） and B （ persistant immunosuppression, 42 cases）. Univariate and multivariate logistic regression analysis were performed to identify the variables associated with immunosuppression. Results The incidence rate of persistant immunosuppression was 40% in this group. Multivariate logistic regression analysis showed that ISS（OR= 2. 41, P〈0. 05）, the worst lactic acid in 24 hours（OR= 1.14, P〈0. 05）, massive transfusion in 24 hours（OR=3.22,P〈0. 01） and the volume of blood transfusion in 72 hours（OR= 2.41, P〈0. 05） were the independent risk factors for persistant immunosuppression, but early enteral nutrition （OR = 0.21, P〈0. 01） was a protective factor. Conclusion Severe trauma, shock, massive transfusion and repeated blood transfusion in 72 hours are the independent risk factors for persistant immunosuppression. Early enteral nutrition is able to promote the recovery of immune function.