小剂量糖皮质激素早期应用对重症腹腔感染患者免疫功能的影响

摘要

目的 分析小剂量糖皮质激素早期应用对重症腹腔感染患者免疫功能的影响.方法 住院治疗的重症腹腔感染患者50例,按随机数字表法分为对照组和试验组,每组25例.对照组给予综合治疗(营养支持、常规抗感染等),试验组采用综合治疗+小剂量氢化可的松治疗.观察2组免疫功能[血清人类白细胞抗原DR位点(HLA-DR)表达、CD4+]、血清炎性因子[白介素-6(IL-6)、白介素-10(IL-10)]、生命体征[平均动脉压(MAP)、心率(HR)、血乳酸及氧合指数(PO2/FIO2)]变化,比较2组预后及并发症.结果 试验组CD4+、IL-6、IL-10水平及HR、血乳酸水平较对照组低,PO2/FIO2较对照组高,住ICU、机械通气及住院时间均较对照组缩短,差异均有统计学意义(P＜0.05);2组HLA-DR表达、MAP、28 d病死率及并发症发生率相比,差异无统计学意义(P＞0.05).结论 小剂量糖皮质激素早期应用于重症腹腔感染中疗效确切,利于提高患者免疫功能,改善血流动力学,降低炎性反应,缩短治疗时间,利于预后.%Objective To investigate the effects of early administration of low dose glucocorticoid on immune function of patients with severe abdominal infection and its clinical effects.Methods Fifty patients with severe intraperitoneal infection who were admitted and treated in our hospital from January 2015 to July 2006 were randomly divided into control group (n =25) and experimental group (n =25).The patients in control group were treated by comprehensive treatment including nutritional support,routine anti-infection,however,the patients in experimental group were treated by combined therapy plus low dose hydrocortisone.The serum levels of HLA-DR,CD4+,IL-6 and IL-10 were detected before and after treatment.The levels of HLA (MAP),heart rate (HR),blood lactate and oxygenation index (PO2/FIO2) were measured.Moreover the patient's prognosis and complications were observed and compared between two groups.Results After treatment,the levels of CD4+,IL-6,IL-10,HR and blood lactic acid in experimental group were obviously lower than those in control group,however,the levels of PO2/FIO2 were higher than those in control group.Moreover ICU staying time,mechanical ventilation and hospitalization time in experimental group were obviously shorter than those in control group (P ＜ 0.05),but there were no significant differences in the levels of HLA-DR expression,MAP,28-day mortality and incidence rate of complications between two groups (P ＞ 0.05).Conclusion The early use of low dose glucocorticoids in treatment of severe abdominal infection is effective,which is benefit to improve immune function of patients,improve hemodynamics,reduce inflammatory response,shorten treatment time,therefor,which is good for patient's prognosis.