温肾暖脾通下方对严重脓毒症患者免疫麻痹的影响

Effects of Wenshen Nuanpi Tongxia Fang(温肾暖脾通下方) on Immunological Paralysis in Patients with Severe Sepsis

目的:观察温肾暖脾通下方治疗严重脓毒症患者的临床疗效及其对免疫麻痹的调节作用。方法:60例严重脓毒症患者随机分为2组,每组30例,对照组采用西医常规治疗,观察组在对照组治疗基础上辅以温肾暖脾通下方治疗。观察2组治疗前及治疗第5 d、第10 d APACHEII评分、免疫学相关指标、降钙素原(PCT)的变化;比较2组ICU住院时间以及28 d死亡率。结果:观察组28 d死亡率为16.7%低于对照组之36.7%,但无统计学差异(χ~2=3.068,P=0.080);观察组ICU住院时间为(12.25±8.32)d,明显短于对照组(19.75±12.56)d(t=2.727,P=0.0084);观察组第5 d、第10 dCD_(14)^+单核细胞人白细胞DR抗原(HLA-DR)、T淋巴细胞亚群(CD_4^+、CD_8^+、CD_4^+/CD_8^+)、自然杀伤细胞(NK细胞)、免疫球蛋白IgG、IgM以及PCT等指标的的改善均优于对照组(P<0.05,P<0.01)。结论:温肾暖脾通下方能增强严重脓毒症患者免疫功能,缩短患者ICU的住院时间,改善预后。

Objective：To observe the curative effect of Wenshen Nuanpi Tongxia Fang on patients with severe sepsis as well as the influence on immunological paralysis.Methods：60 Cases of patients with severe sepsis were randomly divided into observation group and control group with 30 cases each.Both groups were treated with regular western medicine treatment,while Wenshen Nuanpi Tongxia Fang was also used in the observation group.APACHEII scores,immunology related indicators,and the changes of procalcitonin （PCT） in the two groups were observed in the 5thday and 10th day of treatment;compared ICU length of hospital stay,and 28 days total mortality in the two groups.Results：The total mortality rate of the observation group was 16.67% that was no better than the control group which was 36.67% （χ2 =3.068,P =0.080）.Length of time in ICU of the observation group （12.25 ＆#177; 8.32） d was shorter than the control group （19.75-＋ 12.56） d （t =2.727,P =0.0084）.In the 5th day and 10th day of treatment,levels of HLA-DR,and CD4＋ T lymphocyte,CD4＋/CD8＋,natural killer cells （NK cells）,immunoglobulin IgG and IgM in the observation group increased significantly,while the levels of CDs＋ and PCT in the observation group decreased significantly,the differences were statistical significance to compare with control group （P 〈 0.05,P 〈 0.01）.Conclusion：Wenshen Nuanpi Tongxia Fang can enhance immune function of severe sepsis,shorten the length of hospital stay,and improve prognosis of ICU patients.