高渗盐水对创伤失血性休克患者T细胞免疫的影响

目的 观察7.5%高渗盐水对创伤失血性休克患者的早期疗效和对T淋巴细胞亚群的影响.方法 将北京同仁医院急诊科2006年12月至2008年7月收治的早期急性创伤失血性休克患者共82例,随机分为高渗盐水治疗组(高渗盐水组)43例和复方氯化钠溶液治疗组(常规组)39例.纳人标准:来院即刻收缩压＜90mmHg(1 mmHg=0.133 kPa),并且有明确的失血证据.排除标准:既往有免疫系统疾病的患者、来诊24 h内死亡的患者.高渗盐水组立即给予7.5%氯化钠溶液200 mL静脉点滴,于15～20 min内输完,常规组给予复方氯化钠溶液常规复苏治疗.记录复苏开始后10,20,60min点血压及心率的数值并于来诊即刻和复苏24 h后测定血CD3+,CD4+,CD8+水平,使用直接荧光免疫法检测,比较应用高渗盐水和复方氯化钠溶液复苏早期的疗效和对患者T淋巴细胞亚群的影响.两组患者血压、心率、T细胞亚群数值以均数±标准差(x±s)表示,组间比较使用两独立样本t检验,组内比较使用配对t检验;手术例数、并发症例数和死亡例数比较使用X2检验.采用SPSS 11.0统计软件处理数据,以P＜0.05为差异具有统计学意义.结果 高渗盐水组24 h液体输入量为(3820±623)mL,常规组为(5430±1254)mL,两组比较,差异具有统计学意义(P＜0.05).高渗盐水组在输液10 min,20 min后血压明显高于常规组(P＜0.01).伤后24 h高渗盐水组CD3+,CD4+高于常规组(P＜0.01).本研究共治愈63例(76.8%),死亡19例(23.2%),共发生ARDS 10例,MODS 14例.两组患者的死亡率、ARDS发生率、NODS发生率比较,高渗盐水组低于常规组,差异具有统计学意义(P＜0.05).结论 在创伤失血件休克的早期,使用高渗盐水复苏可明显增加有效循环血量,改善组织器官灌注,并可改善患者的T细胞免疫功能,降低ARDS,MODS发生率和死亡率,治疗效果优于常规液体复苏法.

Effects of hypertonic saline on T-lymphocyte subpopulations in patients with traumatically hemorrhagic shock

Objective To investigate the potential and early effect of hypertonic saline resuscitation on Tlymphocyte subpopulations in patients with traumatically hemorrhagic shock.Method Eighty-two patients with acute traumatically hemorrhagic shock admitted from Department of Emergency，Beijing Tongren Hospital，from December 2006 to July 2008 were randomly divided into：hypotonic saline(HS)group(n=43)and Lactated Ringer's solution(LR)group(n=39).The criteria of eligible patients were systolic blood pressure＜90mm Hg at admission with definite evidence of blood loss.Patients with immune system diseases and those who died within 24 hours of admission were excluded.Patients in HS group received intravenous administration of 200 mL of 7.5% sodium chloride withhin 15～20 minutes，and LR group received routine therapy with Lactated Ringer's solution.Blood pressure and heart rate were recorded 10，20，and 60 minutes after the start of resuscitation and compared between two groups.Before and 24 hours after treatment，peripheral blood levels of T-lymphocyte subpopulations including CD3+，CD4+，and CD8+ were measured by using direct immunofluorescence test and compared between two groups.The inter-group comparison was carried out by using independent sample t-lest and intragroup comparison using paired t-test.The numabers of operation，complication cases and death cases were conducted by using X2 test.SPAS version 11.0 software was used for statistical analysis.Results The volume of solution infused in HS group was(3820±623)mL and in LR group was(5430±1254)mL(P＜0.05).At 10 and 20 minutes after the sdministration of solution.the mean blood pressures in HS group were both significantly higher than those in LR group(P＜0.01).The levels of CD3+and CD4+lymphocytes in peripheral blood in HS group 24 hours after treatment were sinificantly higher than those in LR group(P＜0.01).Totally，63(76.8%)patients were cured and 19(23.2%)patients died.ARDS occurred in 10 patients and MODS occurred in 14 patiellts.The mortality，and the rates of ARDS and MODS in HS group were sinificantly higher than those in LP group(P＜0.05).Conclusiom In patients with acute traumatically hemorrhagic shock.HS can increase the effective circulating vol.ume，ameliorate the perfusion of tissues and organs，improve the immune fuction of T-lymphocytes，decrease the rats of ABDS and MODS，mad decrease the morality.HS is more effective than routine solution used for resuscitation.