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Clinical study and long-term evaluation of immunomodulation therapy on trauma, severe sepsis and multiple organ dysfunction syndrome patients
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- Author:
- No author available
- Journal Title:
- CHINESE CRITICAL CARE MEDICINE
- Issue:
- 11
- DOI:
- 10.3760/j.issn:1003-0603.2006.11.007
- Key Word:
- 创伤;严重脓毒症;多器官功能障碍综合征;免疫调理治疗
Abstract： 目的 研究免疫调理治疗对创伤性严重脓毒症和多器官功能障碍综合征(MODS)的作用机制和远期疗效.方法 采用前瞻、随机、单盲和对照的临床研究分析70例符合创伤性严重脓毒症和MODS标准的患者,按随机原则分为对照组(34例)和治疗组(36例).对照组常规治疗;治疗组常规治疗联合使用蛋白酶抑制剂和胸腺肽α1治疗(常规治疗+免疫调理),免疫调理疗程为7 d.分别观察治疗前及治疗后1、3、7、14和28 d淋巴细胞计数和CD14+单核细胞人白细胞DR抗原(HLA-DR)水平等相关免疫学指标动态变化,并收集临床资料和远期随访.结果 住重症监护室(ICU)期间,对照组死亡20例,治疗组死亡13例,病死率比较差异有显著性(P＜0.05);治疗组淋巴细胞计数及CD14+单核细胞HLADR水平在7 d较对照组显著升高,并持续至治疗后28 d(P均＜0.05);治疗组患者机械通气和使用升压药的时间均较对照组明显缩短(P均＜0.01);但治疗组患者的住ICU时间和费用没有显著性增加(P均＞0.05);治疗组远期生存时间较对照组明显延长(P＜0.05).结论 免疫调理治疗可以改善创伤性严重脓毒症和MODS患者住院28 d内的预后,可以升高淋巴细胞计数和CD14+单核细胞HLA-DR水平,从而改善免疫麻痹.免疫调理治疗可以缩短患者机械通气和使用升压药的时间,而不增加ICU的住院时间和费用,有良好的效价比,可以延长远期生存时间,充分显示免疫调理治疗是危重病抢救中成功的治疗策略之一.
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