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目的:观察胸腺肽α1(thymosinα1)对挤压伤伴重度感染、脓毒症患者应用后细胞免疫功能障碍及预后的影响。方法:回顾性选择我院爱心病房2008年5月28-7月31日救治四川汶川地震灾区挤压伤6例伴重症感染、脓毒症患者。在给予积极创面治疗的同时,按病原菌抗生素敏感试验选择敏感抗生素进行抗感染治疗,营养支持及其他对症综合治疗措施外,加用免疫调节剂胸腺肽α1。在治疗前和治疗过程中进行血常规和T淋巴细胞亚群的监测,以评估胸腺肽α1治疗在地震挤压伤伴重度感染、脓毒症患者应用后细胞免疫功能障碍及对预后的影响。结果:经综合治疗后,其中2例极危重挤压综合征患者临床转归达治愈,其余4例伴重度感染、脓毒症患者病情稳定,阻断其发展为多器官功能衰竭。治疗前,所有患者白细胞(Whiteblood cell,WBC)和中性粒细胞(neutrophil,NEUT)有异常增高,治疗后患者异常增高WBC和NEUT明显下降(P<0.05);治疗后患者CD3和CD4淋巴细胞亚群水平有升高趋势;CD4/CD8的比值治疗后较治疗后前有所下降,但无统计学意义(P>0.05)。结论:免疫调节剂胸腺肽α1综合内、外科治疗措施应用于挤压伤伴重度感染、脓毒症患者,可增加CD3、CD4淋巴细胞亚群,下调CD4/CD8比值的趋势,从而减轻全身炎症反应,对患者的预后改观起到一定的作用。
OBJECTIVE: To observe the effect of thymosin α1 on cellular injury and prognosis after crush injury associated with severe infection and sepsis. Methods: retrospectively select our hospital love ward 2008 May 28 - July 31 treatment of crush injury in Wenchuan, Sichuan Province 6 cases with severe infection, sepsis patients. In addition to the treatment of active wounds, thymosin α1, an immunomodulatory agent, is added to the antibiotic susceptibility test of pathogenic bacteria to select anti-infective therapy, nutritional support and other symptomatic comprehensive treatment measures. Blood and T-lymphocyte subsets were monitored before and during treatment to assess the effect of thymosin α1 treatment on earthquake crush injuries with severe infections, post-application cellular immune dysfunction and prognosis in septic patients. Results: After comprehensive treatment, 2 patients with critically extremity crush syndrome were cured and the remaining 4 patients were complicated with severe infection. The patients with sepsis were in stable condition and their progression to multiple organ failure was blocked. Before treatment, the abnormal increase of white blood cell (WBC) and neutrophil (NEUT), the abnormal increase of WBC and NEUT after treatment in all patients (P <0.05); After treatment, the levels of CD3 and CD4 lymphocytes The level of CD4 / CD8 decreased after treatment, but there was no statistical significance (P> 0.05). Conclusions: Thymosin α1, an immunomodulatory agent, can be used in patients with crush injury and severe infection and sepsis to increase the CD3 and CD4 lymphocyte subsets and down-regulate the ratio of CD4 / CD8, so as to reduce the systemic inflammatory response , Improve the prognosis of patients play a role.