重症肺炎合并呼吸衰竭患者免疫调理治疗的临床研究(1)
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2010年4月5日
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[摘要] 目的:探讨对重症肺炎合并呼吸衰竭患者进行免疫调理治疗的临床疗效。方法:53例患者随机分为治疗组和对照组,治疗组在常规抗感染、机械通气等治疗的基础上,进行免疫调理治疗(应用胸腺肽α1和乌司他丁连续7 d),观察两组患者肺部感染控制窗出现时间、机械通气时间、ICU住院时间、治愈率、死亡率等指标的差别。结果:与对照组相比,治疗组的肺部感染控制窗出现时间早,机械通气时间及ICU住院时间短、治愈率高、死亡率低,差异均具有统计学意义(P<0.05)。结论:对重症肺炎合并呼吸衰竭患者进行免疫调理治疗,有利于患者肺部感染的控制,可以提高临床治愈率,降低患者的死亡率。
[关键词] 重症肺炎;呼吸衰竭;免疫调理
[中图分类号] R563.1 [文献标识码]A [文章编号]1674-4721(2010)04(a)-031-02
Clinical researchofimmunomodulatorytreatmentintheseverepneumonia patientswithrespiratoryfailure
LI Panshi
(ICU,Dongguan People′s Hospital,Dongguan 523018, China)
[Abstract] Objective: To investigate the effect of immunomodulatory treatment in the severepneumonia patients with respiratory failure. Methods: 53 patients were divided into two groups randomly,therapy group and control group. All groups were given routine therapy such asanti-infection and ventilation, while the therapy group was given immunomodulatory treatment with thymosin-α1 and ulinastatin at the same time for seven days. Time of pulmonary infection control window,the length of ventilation,the ICU length of stay,the recovery rate and the mortality rate were recorded. Results: After treatment,compared with the control group,time of pulmonary infection control window,the length of ventilation,the ICU length of stay and the mortality rate in therapy group decreased significantly(P<0.05),while the recovery rate was rised significantly(P<0.05). Conclusion: Immunomodulatory treatment in severe pneumoniapatients with respiratory failure is beneficial to pulmonary infection control,it can improve the clinical recovery rate and decrease the mortality rate.
[Key words] Severe pneumonia; Respiratory failure; Immunomodulatory treatment
重症肺炎是指有严重中毒症状或有并发症的肺炎,是临床上常见的急危重症。各年龄段皆可发病,以老年人多见。患者机体免疫炎症反应紊乱,临床表现复杂,常出现呼吸衰竭,需机械通气。胸腺肽α1联合乌司他丁对严重感染患者免疫功能具有调理作用[1],本研究拟联合应用胸腺肽α1及乌司他丁对重症肺炎合并呼吸衰竭患者进行免疫调理治疗,观察其临床疗效。
1 资料与方法
1.1 一般资料
收集本院2007年7月～2009年11月因患重症肺炎出现呼吸衰竭需机械通气入住ICU的患者53例,其中,男33例,女20例,年龄19～86岁,平均(56±14)岁。重症肺炎参照中华医学会呼吸病学分会2006年的诊断标准[2]:肺部感染、且下述临床表现中出现1项或以上者:①意识障碍;②呼吸频率≥30/min;③PaO2<60 mmHg,PaO2/FiO2<300,需行机械通气治疗;④动脉收缩压<90 mmHg;⑤并发脓毒性休克;⑥胸片显示双侧或多肺叶受累,或入院48 h内病变扩大≥50%;⑦少尿:尿量<20 ml/h,或<80 ml/4 h,或急性肾功能衰竭需要透析治疗 ......
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