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目的探讨严重创伤患者早期连续性血液净化(CBP)对免疫功能的影响。方法于2003年1月至2005年10月将22例早期行 CBP 治疗的危重病患者设为治疗组,18例未行 CBP 治疗的危重病患者设为对照组,动态检测两组患者免疫球蛋白(IgG、IgM、IgA)和补体(C_3、C_4),血白介素2(IL-2)水平,观察两组患者的临床变化和急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ评分)。结果两组患者血 IL-2水平、免疫球蛋白和补体较正常组明显下降(P<0.01)。治疗组血 IL-2、IgG、IgA 和 C_3水平于 CBP 治疗后24 h 逐渐上升,IgM 于 CBP 治疗后48 h 逐渐上升。而对照组血 IL-2、IgG、IgM、IgA 和 C_3 7 d 内仍维持较低水平(P<0.05)。治疗组在 CBP 治疗后 APACHEⅡ评分下降明显(P<0.01),感染发生率、多器官功能障碍综合征(MODS)发生率和病死率较对照组低(P<0.05)。结论严重创伤患者早期处于免疫抑制状态,CBP 治疗可改善患者的免疫抑制,改善病情。
Objective To investigate the effect of early continuous blood purification (CBP) on immune function in patients with severe trauma. Methods From January 2003 to October 2005, 22 cases of CBP-treated critically ill patients were enrolled as treatment group and 18 cases of CBP-untreated critically ill patients as control group. The dynamic changes of immunoglobulin (IgG, IgM, IgA), complement (C_3, C_4) and interleukin 2 (IL-2) were measured. The clinical changes, acute physiology and chronic health status Ⅱ scores (APACHEⅡscores) were observed in two groups. Results The levels of IL-2, immunoglobulin and complement in the two groups were significantly lower than those in the normal group (P <0.01). The levels of IL-2, IgG, IgA and C_3 in the treatment group increased gradually 24 h after CBP treatment, and IgM gradually increased 48 h after CBP treatment. The levels of IL-2, IgG, IgM, IgA and C_3 in the control group remained low (P <0.05). The APACHEⅡscore decreased significantly (P <0.01), the incidence of infection, the incidence of multiple organ dysfunction syndrome (MODS) and mortality in the treatment group were lower than those in the control group (P <0.05). Conclusions Serious trauma patients are immunosuppressed in the early stage. CBP treatment can improve immunosuppression and improve the condition of patients.