摘要
【目的】探讨心脏术后体外膜肺氧合（ECOM）支持患者的呼吸道感染现状及其对机体免疫功能的影响。【方法】选择2016年3月至2018年2月本院收治的心脏术后应用ECOM支持治疗的32例呼吸道感染经痰培养病原学阳性患者的临床资料。分析患者呼吸道感染痰培养病原学结果，比较治疗前及治疗后12h、24h及36h患者免疫球蛋白[IgA、IgM、IgG]、T细胞亚群[CD3^＋、CD4^＋、CD8^＋]及血浆心钠肽（ANP）、脑钠肽（BNP）、氨基末端B型脑钠肽前体（NT-proBNP）的水平。【结果】本组共分离病原茵32株，其中革兰阴性杆菌21例（65．63％），革兰阳性球茵7例（21．88％），真菌4例（12．50％）。治疗后12h、24h、36h患者血清IgA、IgM、IgG水平均低于治疗前，且治疗后12h患者IgA、IgM、IgG水平下降至最低点，此后逐渐上升，但仍显著低于治疗前，差异均具有统计学意义（P〈0．05）。治疗12h、24h、36h患者CD3^＋、CD4^＋、CD8^＋水平均较治疗前有所下降，且治疗12h患者CD3^＋、CD4^＋、CD8^＋水平下降至最低点，此后逐渐上升，但仍显著低于治疗前，差异具有统计学意义（P〈0．05）。治疗12h、24h、36h患者血浆ANP、BNP、NT-proBN水平均较治疗前有所下降，且治疗后12h患者血浆ANP、BNP、NT-proBN水平下降至最低点，此后逐渐上升，但仍显著低于治疗前，差异均具有统计学意义（P〈0．05）。【结论】心脏术后应用ECMO支持治疗患者的呼吸道感染发病率较高，其对患者机体免疫功能及血浆ANP、BNP、NT-proBN水平有一定程度的抑制作用。
[Objective]To investigate the status of respiratory tract infection in patients with extracorporeal membrane oxygenation （ECMO） after cardiac surgery and its effect on immune function.[Methods]From March 2016 to February 2018, 32 patients with respiratory tract infection positive for sputum culture were selected and treated with ECMO support. The pathogenic results of sputum culture in patients with respiratory tract infection were analyzed. The levels of immunoglobulin（IgA.IgM.IgG）, T cell subsets （CD3＋ , CD4＋ , CD8＋ ）, plasma at- rial natriuretic peptide （ANP）, brain natriuretic peptide （BNP） and N-terminal B-type brain natriuretic peptide precursor （NT-proBNP）were compared before treatment and 12 h ,24h and 36 h after treatment.[Results] A total of 32 strains of pathogens was isolated, of which 21 were gram-negative bacilli （65.63%）, 7 were gram-positive cocci （21.88%）, 4 were fungi （12.50%）. 12 hours, 24 hours and 36 hours after treatment, the serum levels of IgA, IgM and IgG were lower than those before treatment, and the level of IgA, IgM and IgG decreased to the lowest point at 12 hours after treatment, and then gradually increased, but still significantly lower than before the treatment, the difference was statistically significant （ P〈0.05）. 12 hours and 24 hours and 36 hours after treat- ment, the levels of CD3＋ , CD4＋ and CD8＋ in the patients were all decreased compared with those before treat- ment. 12 hours of treatment, the levels of CD3＋ CD4＋ and CD 8＋ decreased to the lowest point, and then gradual- ly increased, but still significantly lower than those before treatment. The difference was statistically significant （ P〈0.05）. The plasma levels of ANPBNPNT-proBN in the patients decreased to the lowest level 12 hours after treatment, and gradually increased after 12 hours of treatment, but still significantly lower than those before treat-ment, and the levels of ANP,BNP, NT-proBN in plasma decreased to the lowest level 12 hours after
作者
张鹏宇
汤楚中
潘绪
迟海涛
孙文婷
王志坚
ZHANG Peng-yu;TANG Chuzhong;PAN Xu(Cardiovascular Surgery, General Hospital of the Chinese People＇s Liberation Army, Beijing 100048)
出处
《医学临床研究》
CAS
2018年第6期1120-1123,共4页
Journal of Clinical Research
关键词
心脏外科手术
体外膜氧合作用
呼吸道感染
免疫测定
Cardiac Surgical Procedures
Extracorporeal Membrane Oxygenation
Respiratory TractInfections
Immunoassay
