脓毒血症患者免疫功能的改变与治疗对策

Sepsis patients immune function change and treatment countermeasures

目的探讨脓毒血症患者免疫功能的改变与治疗对策。方法选取2014年2月—2015年2月我院收治的26例脓毒血症患者为研究对象,回顾性分析其临床资料,观察患者免疫功能的改变及治疗的对策。结果本组26例患者,经容量复苏、血管活性用药及抗生素治疗后,平均住ICU时间(13.2±2.4)d,机械通气时间(10.3±2.5)d,死亡率23.08%(6/26),治疗后4 d T淋巴细胞亚群各值均低于治疗后1 d,差异有统计学意义(P<0.05),外周血淋巴细胞治疗后1 d低于术前,治疗后6 d高于治疗后1 d,差异无统计学意义(P>0.05);治疗后APACHEⅡ评分、SOFA评分与MODS评分均呈下降趋势,治疗后6 d与治疗后1 d比较,差异无统计学意义(P>0.05)。结论在临床治疗过程中,应积极监测T淋巴细胞亚群与外周血淋巴细胞,持续降低则表示预后不良,其监测方法简便,值得在临床上推广。

Objective： To study spesis patients immune function changes and treatment countermeasures. Methods： To select 26 sepsis patients as research object from 2014. 2 to 2015. 2 and analyze retrospectively their clinical data,observe their immune function changes and treatment measures. Results： After capacity recovery,vascular active drugs and antibiotics treatment,ICU average time was（ 13. 2 ± 2. 4） d,mechanical ventilation time was（ 10. 3 ± 2. 5） d,death rate was23. 08%（ 6 /26）,4d after treatment,T ymphocyte subsets every value was lower than 1d after treatment,there were statistical difference（ P〈0. 05）,1d after treatment,preoperative peripheral blood lymphocytes was lower than before treatment,there were statistical difference（ P〈0. 05）; after treatment,APACHE II score,SOFA score and MODS score was declining,comparing 6d after treatment with 1d after treatment,there were not statistical difference（ P〉0. 05）. Conclusion：During clinical treatment process,it is necessary to actively monitor T lymphocyte subgroup and peripheral blood lymphocytes and reduce indicates poor prognosis. It features simple monitoring method and worth of popularizing in clinic.