目的评估联合抗炎和免疫刺激治疗严重脓毒症方法的有效性。方法本研究采用多中心、前瞻、随机、对照方法。共433例患者进入本研究。进入 ICU 内严重脓毒症(Marshall 评分5～20)的患者入选,随机分为对照组:常规治疗;治疗组1(第1阶段):常...目的评估联合抗炎和免疫刺激治疗严重脓毒症方法的有效性。方法本研究采用多中心、前瞻、随机、对照方法。共433例患者进入本研究。进入 ICU 内严重脓毒症(Marshall 评分5～20)的患者入选,随机分为对照组:常规治疗;治疗组1(第1阶段):常规治疗+乌司他丁30万 U/日,α1胸腺肽(迈普新)1.6 mg/d,连续7 d;治疗组2(第2阶段):常规治疗+乌司他丁60万 U/日,迈普新3.2 mg/日,连续7 d,进行28 d 和90 d 预后等疗效评估。结果第1阶段91例,治疗组(治疗组1)与对照组28 d 预后等各项疗效评估指标差异均无统计学意义。第2阶段342例,治疗组(治疗组2)与对照组相比(意向治疗分析),28 d 病死率为25.1%vs 38.3%(P=0.0088),90 d 病死率为37.1%vs 52.1%(P=0.0054),28 d APACHEⅡ评分12.7±9.4 vs 14.3±9.2(P=0.0384),28 d 单核细胞 HLA-DR/CD14+(51.7±26.5)%vs(40.1±22.0)%(P=0.0092)。其他疗效评估指标,如 ICU内治疗天数、呼吸机使用天数、抗生素使用时间等,两组差异无统计学意义。结论本研究治疗方案能够明显改善严重脓毒症患者28 d 和90 d 预后,具有积极推广价值;治疗的有效性具有剂量依赖性,最佳剂量有待进一步探讨。展开更多
Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operatio...Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis’. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.展开更多
文摘目的评估联合抗炎和免疫刺激治疗严重脓毒症方法的有效性。方法本研究采用多中心、前瞻、随机、对照方法。共433例患者进入本研究。进入 ICU 内严重脓毒症(Marshall 评分5～20)的患者入选,随机分为对照组:常规治疗;治疗组1(第1阶段):常规治疗+乌司他丁30万 U/日,α1胸腺肽(迈普新)1.6 mg/d,连续7 d;治疗组2(第2阶段):常规治疗+乌司他丁60万 U/日,迈普新3.2 mg/日,连续7 d,进行28 d 和90 d 预后等疗效评估。结果第1阶段91例,治疗组(治疗组1)与对照组28 d 预后等各项疗效评估指标差异均无统计学意义。第2阶段342例,治疗组(治疗组2)与对照组相比(意向治疗分析),28 d 病死率为25.1%vs 38.3%(P=0.0088),90 d 病死率为37.1%vs 52.1%(P=0.0054),28 d APACHEⅡ评分12.7±9.4 vs 14.3±9.2(P=0.0384),28 d 单核细胞 HLA-DR/CD14+(51.7±26.5)%vs(40.1±22.0)%(P=0.0092)。其他疗效评估指标,如 ICU内治疗天数、呼吸机使用天数、抗生素使用时间等,两组差异无统计学意义。结论本研究治疗方案能够明显改善严重脓毒症患者28 d 和90 d 预后,具有积极推广价值;治疗的有效性具有剂量依赖性,最佳剂量有待进一步探讨。
文摘Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis’. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.
