严重多发伤合并脓毒症患者围手术期使用复合免疫治疗的疗效

Efficacy of Perioperative Complex Immunotherapy for Patients with Severe Multiple Injuries Complicated with Sepsis

目的探讨严重多发伤合并脓毒症患者围手术期使用卡文联尤文行复合免疫治疗的疗效。方法纳入该院急重症医学科于2012年1月—2013年1月收治严重多发伤合并脓毒症的患者,共得到64例符合要求的患者,将其随机均分为对照组(n=32)及实验组(n=32)。观察所有患者治疗前及治疗一周时简化急性生理学评分Ⅱ、慢性健康状况评价Ⅱ、总蛋白、白蛋白、促红细胞生成素、超敏C反应蛋白、肿瘤坏死因子-α、白介素6、降钙素原、CD4+、CD8+及CD4+/CD8+比值的差异。结果通过一周的对比治疗,实验组的简化急性生理学评分Ⅱ显著降低、慢性健康状况评价Ⅱ显著降低,差异有统计学意义(P<0.05),说明身体机能得到显著恢复;超敏C反应蛋白显著降低、肿瘤坏死因子-α显著降低、CD4+显著增加、CD8+显著增加、CD4+/CD8+比值显著增加,差异有统计学意义(P<0.05),说明机体免疫功能得到改善。结论对于严重多发伤合并脓毒症患者围手术期予以复合免疫治疗,有助于维持免疫动态平衡,促使机体恢复促炎和抗炎平衡,改善预后。

Objective To observe the efficacy of perioperative complex immunotherapy of Kabiven and Omegaven for patients with severe multiple injuries complicated with sepsis. Methods 64 patients with severe multiple injuries complicated with sepsis admitted to the ICU of our hospital who met the criteria were randomized into control group(n=32) and experimental group(n=32). The simplified acute physiology score II(SAPS II), chronic health evaluation Ⅱ(CHE Ⅱ), total protein(TP), albumin(ALB), erythropoietin(EPO), high sensitive C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), procalcitionin(PCT),CD4+, CD8+and CD4+/CD8+ratio before and 1 week after treatment were observed and compared between the two groups. Results After one week treatment, SAPS II and CHE Ⅱ decreased significantly and showed statistical differences with those before treatment(P<0.05), which meant that their physical functions were improved significantly; TNF-α, IL-6, CD4+, CD8+and CD4+/CD8+ratio increased significantly and showed statistical differences with those before treatment(P<0.05), which meant that their immune functions were improved significantly. Conclusion For patients with severe multiple injuries complicated with sepsis, perioperative complex immunotherapy of Kabiven and Omegaven can contribute to the maintaining of dynamic balance of immune function, promote the restoration of pro/Anti-inflammatory balance, and improve prognosis.