發(fā)布時間：2018-07-09 12:09

  本文選題：脾多肽 + 燒傷��； 參考：《延安大學》2015年碩士論文

【摘要】：研究背景:燒傷后機體會出現(xiàn)不同程度的免疫功能紊亂已被大量的臨床和實驗資料證實。燒傷后患者免疫功能紊亂(Immune dysfunction)是導致機體嚴重感染、多器官功能障礙綜合癥(MODS)、全身炎癥反應綜合癥(SIRS)甚至死亡的重要誘因。如何糾正患者的免疫紊亂,提高機體抵抗致病菌的能力,減少并發(fā)癥,提高治愈率一直是臨床工作者關注的問題。隨著分子生物學的發(fā)展,制藥工程技術的提高,人們開發(fā)出多種免疫調節(jié)劑用于臨床治療。近年來脾多肽注射液作為一種新型免疫調節(jié)藥物,被廣泛應用于惡性腫瘤、呼吸道及肺部感染、原發(fā)性和繼發(fā)性細胞免疫缺陷病等,取得了很好的療效,但關于脾多肽注射液在燒傷救治中的具體療效卻鮮有報道。目的:探討脾多肽注射液對重度燒傷患者T淋巴細胞亞群的影響。為臨床治療重度燒傷時如何糾正機體免疫功能紊亂提供依據(jù),從而減輕機體感染程度,降低多器官功能衰竭的發(fā)生率,減少并發(fā)癥,提高救治率,縮短住院時間,減少患者痛苦。方法:選取2013年3月至2014年11月延安大學附屬醫(yī)院燒傷整形手外科收治的52例(其中2例患者放棄治療、1例出現(xiàn)不良反應,被剔除)重度燒傷患者,經(jīng)患者知情同意分成2組。治療組在入院后第2天起,接受脾多肽注射液治療,在500 ml 0.9%氯化鈉注射液中加入10 ml脾多肽注射液,靜脈滴注,每日1次,療程14 d;對照組不給予脾多肽注射液治療,其余常規(guī)治療(包括補液、抗感染、對癥支持治療、創(chuàng)面處理等)兩組相同。分別于治療前與治療后第7、14、2l天抽取患者外周靜脈血,采用流式細胞儀檢測兩組患者T淋巴細胞總數(shù)(CD3+)及T淋巴細胞亞群(CD4+、CD8+、CD4+/CD8+)數(shù)作為觀察指標;分別于治療后第7、14、21天對兩組患者進行血液細菌培養(yǎng)及創(chuàng)面分泌物細菌培養(yǎng),記錄陽性人數(shù);觀察和記錄病程中并發(fā)相關系統(tǒng)感染的人數(shù)。1.兩組患者外周靜脈血T淋巴細胞亞群比較:兩組患者在治療前及治療后7天、14、21天外周血T淋巴細胞總數(shù)(CD3+),差異均無統(tǒng)計學意義(P0.05)。兩組患者在治療前CD4+細胞數(shù)比較,差異無統(tǒng)計學意義(P0.05);治療后第7天、14天、21天兩組患者CD4+細胞數(shù)比較,差異均有統(tǒng)計學意義(P0.05),治療組CD4+細胞數(shù)高于對照組。兩組患者在治療前及治療后第7天CD8+細胞數(shù)比較,差異均無統(tǒng)計學意義(P0.05);治療后第14天、21天兩組患者CD8+細胞數(shù)比較,差異均有統(tǒng)計學意義(P0.05),治療組CD8+低于于對照組。兩組患者在治療前CD4+/CD8+比值比較,差異無統(tǒng)計學意義(P0.05);治療后第7天、14天、21天CD4+/CD8+比值比較,差異均有統(tǒng)計學意義(P0.05),治療組CD4+/CD8+比值高于對照組。2.兩組患者相關感染情況比較:入院時,兩組患者都沒有相關感染的表現(xiàn);整個研究過程中,兩組患者血培養(yǎng)均為陰性,也沒有呼吸系統(tǒng)的感染發(fā)生。治療后第14、21天,治療組創(chuàng)面細菌培養(yǎng)陽性人數(shù)明顯少于對照組,兩組患者于治療后14天創(chuàng)面細菌培養(yǎng)陽性率分別是:治療組:8%,對照組:20.8%;治療后21天創(chuàng)面細菌培養(yǎng)陽性率分別是:治療組:0%,對照組:8.3%;整個研究過程中,治療組留置導尿的患者12例,對照組留置導尿的患者11例,治療后第14天,兩組留置導尿的患者中,出現(xiàn)泌尿系統(tǒng)感染的幾率分別為0%和18.2%。結果:結論:脾多肽注射液作為免疫調節(jié)劑,對機體免疫功能具有調節(jié)作用,能夠糾正重度燒傷引起的機體T淋巴細胞亞群失衡,加強機體抵抗力,減少并發(fā)癥,提高救治率。
[Abstract]:Background: a large number of clinical and experimental data have been confirmed by various levels of immune dysfunction after burns. The immune dysfunction (Immune dysfunction) after burn is an important cause of severe infection of the body, multiple organ dysfunction syndrome (MODS), systemic inflammatory response syndrome (SIRS) and even death. It is a problem for clinical workers to correct the immune disorder of the patients, improve the body's ability to resist pathogenic bacteria, reduce the complications and improve the cure rate. With the development of molecular biology and the improvement of pharmaceutical engineering technology, many kinds of immunomodulators have been developed for clinical treatment. In recent years, Lienal Polypeptide Injection has been a new type of exemption. Pestilence drugs have been widely used in malignant tumor, respiratory and pulmonary infection, primary and secondary cell immunodeficiency diseases, and so on. The effect of Lienal Polypeptide Injection in the treatment of burn is rarely reported. Objective: To explore the effect of Lienal Polypeptide Injection on T lymphocyte subsets in severe burn patients. It provides a basis for correcting the immune function disorder in the clinical treatment of severe burns, thus reducing the degree of infection, reducing the incidence of multiple organ failure, reducing complications, improving the cure rate, shortening the time of hospitalization and reducing the pain of the patients. Methods: to select the burn and plastic hands of Affiliated Hospital of Yan'an University from March 2013 to November 2014. 52 cases of surgical treatment (2 of them gave up treatment, 1 cases had adverse reactions, were eliminated) and were divided into 2 groups by informed consent. The treatment group received Lienal Polypeptide Injection treatment for second days after admission, 10 ml Lienal Polypeptide Injection in 500 ml 0.9%, intravenous drip, 1 times a day, 14 d course of treatment; The control group was not treated with Lienal Polypeptide Injection, and the rest of the conventional treatment (including rehydration, anti infection, symptomatic support treatment, wound treatment, etc.) were the same in the two groups. The peripheral venous blood was extracted from the patients before and after the treatment on day 7,14,2l, and the total number of T lymphocytes (CD3+) and T lymphocyte subgroup (CD4+, CD8) were detected by flow cytometry. The number of +, CD4+/CD8+) was used as the observation index; the blood bacteria culture and the bacterial culture of the wound exudates were recorded on the two groups of patients on the 7,14,21 day after treatment, and the positive number was recorded. The number of T drenching subgroups in the peripheral venous blood of the group of.1. two patients was observed and recorded in the course of the disease, and the two groups were treated before and treated. 7 days after treatment, the total number of T lymphocytes in peripheral blood (CD3+) in 14,21 days was not statistically significant (P0.05). There was no significant difference in the number of CD4+ cells in the two groups before treatment (P0.05), and the number of CD4+ cells in the two groups after seventh days, 14 days and 21 days after treatment was statistically significant (P0.05), and the number of CD4+ cells in the treatment group was higher than that of the control group. There was no significant difference in the number of CD8+ cells between the two groups before and seventh days after treatment (P0.05), and the number of CD8+ cells in two groups of two groups after treatment was statistically significant (P0.05), and the CD8+ in the treatment group was lower than that in the control group. There was no statistical difference between the two groups before the treatment (P0.05). Seventh days after treatment, 14 days, 21 days CD4+/CD8+ ratio, the difference was statistically significant (P0.05), CD4+/CD8+ ratio in the treatment group was higher than the control group.2. two patients related infection situation: at admission, the two groups of patients had no related infection performance; the whole study process, the two groups of blood culture were negative, nor respiratory system. Infection occurred. On day 14,21 after treatment, the number of positive bacteria culture in the treatment group was significantly less than that of the control group. The positive rate of bacterial culture in the two groups was 8%, the control group was 20.8% after 14 days after treatment, and the positive rate of bacterial culture in the 21 day after treatment was: the treatment group: 0%, the control group: 8.3%; the whole treatment process, treatment, treatment, treatment, treatment, and treatment. Group 12 cases of indwelling catheterization, 11 cases of the control group with indwelling catheterization, fourteenth days after treatment, two groups of indwelling urinary catheterization, the incidence of urinary system infection was 0% and 18.2%. results: conclusion: Lienal Polypeptide Injection as an immune modulator, the immune function of the body can have a regulatory effect, can correct severe burns caused by the machine The imbalance of T lymphocyte subsets can enhance body resistance, reduce complications and improve the treatment rate.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R644

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相關期刊論文 前1條

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本文編號：2109319