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目的分析严重创伤患者免疫功能持续抑制的影响因素。方法 ICU收治的严重创伤患者104例,创伤严重度评分(ISS)>25分。其中,一过性免疫功能抑制组62例,单核细胞人白细胞抗原DR(mHLA-DR)在1周内表达率能恢复到80%以上,持续性免疫功能抑制组42例,1周内mHLA-DR表达率的恢复<80%。对患者的临床资料分别进行Logistic单因素和多因素回归分析。结果持续性免疫功能抑制发生率40%。Logistic多因素分析示:ISS(OR=2.41,P<0.05)、入院24-h血乳酸值(OR=1.14,P<0.05)、入院24h内大量输血(OR=3.22,P<0.01)和入院72h内输血量(OR=2.41,P<0.05)是mHLA-DR持续低表达的独立危险因素;而早期肠内营养(OR=0.21,P<0.01)是mHLA-DR恢复的有利因素。结论严重创伤、休克、早期大量输血和反复输血是严重创伤患者免疫功能持续抑制的独立危险因素,早期肠内营养能促进免疫功能的恢复。
Objective To analyze the influencing factors of continuous suppression of immune function in patients with severe trauma. Methods A total of 104 patients with severe traumatic injury admitted to the ICU were enrolled in this study. The severity of trauma (ISS) score> 25. Among them, the expression of mHLA-DR monocytes in 62 patients with transient immunosuppression group was over 80% in 1 week, 42 cases in persistent immunosuppression group and 1 week in mHLA Recovery of -DR expression was <80%. The clinical data of patients were analyzed by Logistic single factor and multivariate regression respectively. Results The incidence of persistent immune suppression was 40%. Logistic multivariate analysis showed that 24 h blood lactic acid (OR = 1.14, P <0.05), 24 h admission blood transfusion (OR = 3.22, P <0.01) The amount of blood transfusion within 72h (OR = 2.41, P <0.05) was an independent risk factor for sustained low expression of mHLA-DR. Early enteral nutrition (OR = 0.21, P <0.01) was a favorable factor for the recovery of mHLA-DR. Conclusion Severe trauma, shock, early massive blood transfusion and repeated blood transfusion are independent risk factors for the sustained suppression of immune function in severe trauma patients. Early enteral nutrition can promote the recovery of immune function.