呼吸机相关肺炎患儿细胞免疫与炎性状态的变化观察

发布时间：2018-11-09 20:24

【摘要】：目的探讨呼吸机相关肺炎患儿细胞免疫与炎性状态变化,以期为呼吸机相关肺炎的预防提供依据。方法选取2013年1月-2015年1月医院收治接受机械通气患儿104例,根据呼吸机相关肺炎发生情况分为A组与B组,A组60例为发生呼吸机相关肺炎患儿,B组44例为未发生呼吸机相关肺炎患儿。观察两组患儿治疗情况,插管前及插管后不同时间炎性因子情况及T淋巴细胞情况,据CD4+、CD8+计算(CD4+/CD8+)比值。结果两组患儿治疗期间均未见死亡及撤机失败患儿,两组患儿机械通气时间、气道损伤发生率及血氧饱和度80%发生率对比,差异无统计学意义;A组插管96h细胞免疫CD4+、CD8+、CD4+/CD8+比值指标与同组插管时及B组同期对比,差异有统计学意义(P0.05);A组插管48h细胞免疫CD8+指标与插管时对比,差异有统计学意义(P0.05),A组插管48hCD4+、CD8+及CD4+/CD8+比值指标与对照组同期对比,差异有统计学意义(P0.05);B组插管48h、96h各项细胞免疫指标与同组插管时对比,差异有统计学意义(P0.05)。两组插管48h、96h各项炎症因子水平均低于同组插管时,差异有统计学意义(P0.05);A组插管48h、96h各项炎性因子水平均高于B组同期,差异有统计学意义(P0.05)。结论细胞免疫与炎性状态对呼吸机相关肺炎发生具有预测作用,使用呼吸机后,应加强免疫细胞及炎性因子监测,以预防呼吸机相关肺炎发生,为成功撤机奠定基础。
[Abstract]:Objective to investigate the changes of cellular immunity and inflammatory state in children with ventilator-associated pneumonia in order to provide evidence for the prevention of ventilator-associated pneumonia. Methods 104 children with mechanical ventilation were selected from January 2013 to January 2015. According to the incidence of ventilator-associated pneumonia, they were divided into two groups: group A and group B, and group A consisted of 60 children with ventilator-associated pneumonia. Group B (44 cases) had no ventilator-associated pneumonia. The conditions of treatment, inflammatory factors and T lymphocytes before and after intubation were observed, and the ratio of CD4 / CD8 was calculated according to CD4 and CD8. Results there was no death or failure of weaning in both groups. There was no significant difference in the time of mechanical ventilation, incidence of airway injury and 80% of blood oxygen saturation between the two groups. The ratio of CD4, CD8, CD4 / CD8 in group A was significantly higher than that in group B and group B at 96 h after intubation (P0.05). The CD8 index of cellular immunity in group A was significantly higher than that in group A at 48 h after intubation (P0.05). The indexes of 48hCD4, CD8 and CD4 / CD8 ratio in), A group were significantly higher than those in control group (P0.05). In group B, the cellular immunity indexes were significantly different from those in the same group at 48h and 96h (P0.05). The levels of inflammatory factors in); A group were significantly higher than those in group B at 48h and 96h after intubation (P0.05). Conclusion the cellular immunity and inflammatory state can predict the occurrence of ventilator-associated pneumonia. The monitoring of immune cells and inflammatory factors should be strengthened after the use of ventilator in order to prevent the occurrence of ventilator-associated pneumonia and lay the foundation for successful weaning.
【作者单位】：南阳市第一人民医院儿二科;南阳医专第一附属医院呼吸科;
【分类号】：R725.6

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