连续血液净化联合丙种球蛋白对重症脓毒患儿炎症介质清除及免疫状态的影响

Effect of continuous blood purification combined with gamma globulin on clearance of inflammatory mediators and immune status in children with severe sepsis

目的探讨选用丙种球蛋白^+连续血液净化(CBP)方案给予重症脓毒患儿临床救治的效果及价值。方法收集2018年6月至2019年8月本院收治35例重症脓毒患儿临床资料作为对象,按救治方法进行分组,对照组15例给予CBP治疗,观察组20例给予连续血液净化^+丙种球蛋白治疗,回顾分析患儿炎症反应控制、免疫功能改善及预后情况。结果观察组治疗后肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)水平均低于对照组,差异有统计学意义(P<0.05);观察组治疗后CD3^+、CD4^+、CD8^+及CD4^+/CD8^+相比对照组均明显更高,自然杀伤细胞明显更低,差异均有统计学意义(P<0.05);观察治疗后APACHEⅡ评分、SOFA评分均低于对照组,平均ICU住院时间短于对照组,差异有统计学意义(P<0.05)。结论给予重症脓毒患儿CBP联合丙种球蛋白治疗,可有效提高炎症控制效果,增强患儿免疫功能,提高总疗效,有助于改善患儿预后。

Objective To evaluate the effect and value of clinical treatment for severe sepsis children with gamma globulin and continuous blood purification(CBP).Methods The clinical data of 35 children with severe sepsis were collected from June 2018 to August 2019,and the patients were divided into groups according to the treatment method;control group(15 cases)was treated with CBP,while observation group(20 cases)was given continuous blood purification^+gamma globulin treatment.The control of inflammatory reaction,improvement in immune function and prognosis in children were analyzed retrospectively.Results After treatment the levels of TNF-α,CRP and PCT in the observation group were lower than those in the control group(P<0.05);CD3^+,CD4^+,CD8^+and CD4^+/CD8^+were significantly higher and NK cells were significantly lower in the observation group than in the control group(P<0.05).After treatment,APACHEⅡscore and SOFA score were lower in observation group than in the control group,and the average length of ICU stay was shorter than in the control group(P<0.05).Conclusion Treatment with CBP and gamma globulin for children with severe sepsis can effectively improve the effect of inflammation control,enhance the immune function of children,increase the total curative effect,and help improve the prognosis of children.