静注人免疫球蛋白联合万古霉素治疗小儿败血症的疗效及外周血NLR、PCT变化观察

Curative Effect of Intravenous Injection of Human ImmunoglobulinCombined with Vancomycin in the Treatment of Children with Sepsis andChanges in Peripheral Blood NLR and PCT

目的:观察静注人免疫球蛋白联合万古霉素治疗小儿败血症的疗效及外周血中性粒细胞/淋巴细胞比值(NLR)、降钙素原(PCT)变化。方法:选取2011年1月~2020年1月我院收治的败血症患儿80例为研究对象,按数字随机表法分为对照组和观察组各40例,对照组给予万古霉素治疗,观察组在对照组基础上给予静注人免疫球蛋白治疗,比较两组临床疗效、症状改善时间和住院时间、NLR、PCT、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、免疫功能及不良反应发生率。结果:观察组治疗有效率高于对照组(87.50%vs65.00%)(P<0.05)。观察组神经系统症状改善时间、体温改善时间、拒奶改善时间和住院时间为(6.22±1.05)d、(3.88±0.25)d、(5.10±0.86)d、(8.71±2.05)d,均短于对照组的(8.76±1.53)d、(6.22±0.64)d、(7.53±1.46)d和(11.24±3.36)d,比较差异有统计学意义(P<0.05)。治疗后观察组外周血NLR、PCT、hs-CRP、WBC水平为(1.35±0.20)、(0.80±0.34)mg/mL、(3.56±0.62)g/L、(9.12±1.80)×10^(9)/L,均显著低于对照组的(1.83±0.32)、(2.19±0.73)mg/mL、(9.78±2.64)g/L和(12.26±2.59)×10^(9)/L,比较差异有统计学意义(P<0.05)。治疗后观察组CD4^(+)、CD3^(+)、CD4/CD8为(42.77±11.36)%、(41.27±11.26)%、(1.70±0.33),均显著高于对照组的(35.80±9.32)%、(35.66±9.40)%和(1.29±0.25),比较差异有统计学意义(P<0.05)。两组不良反应发生率比较无差异(10.00%vs7.50%)(P>0.05)。结论:静注人免疫球蛋白联合万古霉素治疗小儿败血症的疗效显著,可降低炎症因子,提高免疫功能,且安全性较高。

Objective:To observe the curative effect of intravenous injection of human immunoglobulin combined with vancomycin in the treatment of children with sepsis,and changes in peripheral blood neutrophil-to-lymphocyte ratio(NLR)and Procalcitonin(PCT).Methods:Eighty children with sepsis admitted to the hospital from January 2011 to January 2020 were selected as the research subjects.They were divided into control group and observation group according to the random number table method,with 40 cases in each group.Children in control group were treated with vancomycin,and those in observation group were treated with intravenous injection of human immunoglobulin based on the treatment of control group.Clinical efficacy,symptom improvement time,length of hospital stay,NLR,PCT,Procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),White blood cell count(WBC),immune function and the incidence of adverse reactions were compared between the two groups.Results:The treatment response rate in observation group was higher than that in control group(87.50%vs.65.00%)(P<0.05).The improvement time of nervous system symptoms,body temperature and milk refusal,and the length of hospital stay in observation group[(6.22±1.05)d,(3.88±0.25)d,(5.10±0.86)d and(8.71±2.05)d]were shorter than those in control group[(8.76±1.53)d,(6.22±0.64)d,(7.53±1.46)d and(11.24±3.36)d](P<0.05).After treatment,peripheral blood NLR,serum PCT,hs-CRP and WBC levels in observation group[(1.35±0.20),(0.80±0.34)mg/mL,(3.56±0.62)g/L and(9.12±1.80)×10^(9)/L]were significantly lower than those in control group[(1.83±0.32),(2.19±0.73)mg/mL,(9.78±2.64)g/L and(12.26±2.59)×10^(9)/L](P<0.05).After treatment,CD4^(+),CD3^(+)and CD4/CD8 in observation group[(42.77±11.36)%,(41.27±11.26)%and(1.70±0.33)]were significantly higher than those in control group[(35.80±9.32)%,(35.66±9.40)%and(1.29±0.25)](P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(10.00%vs.7.50%)(P>0.05).Conclusion:Intravenous injection of human immunoglobulin combined with vancomycin is effective in the treatment of children with sepsis,which Can reduce inflammatory factors,and improve immune function,with high safety.