适度镇静对AECOPD患者免疫功能的影响

目的观察适度镇静治疗对AECOPD机械通气患者免疫功能的影响。方法 AECOPD机械通气患者59例随机分为:传统镇静组(A组)28例和适度镇静组(B组)31例。A组常规应用负荷剂量芬太尼、咪达唑仑后持续静脉泵注镇静;B组用药同A组,但使用程序性镇静和每日唤醒的策略。记录镇静过程中两组患者的血压、心率、气道峰值压力等波动情况,检测治疗前和治疗后第7天外周血IgG、IgA、IgM、CD3、CD4/CD8、HLA-DR等免疫功能指标及CRP、TNF、IL-8水平变化。结果 A组患者躁动、血压、心率、呼吸、气道峰值压力波动发生率高于B组(P<0.01);B组患者的IgA、IgG、HLA-DR、CD4/CD8治疗后上升,高于治疗前和A组(P<0.05);两组患者CRP、TNF、IL-8水平较治疗前有下降(P<0.05),但B组TNF、IL-8水平较治疗前明显下降(P<0.01),与A组比较,差异明显(P<0.05)。结论适度镇静治疗对机体免疫功能和炎症反应具有调控作用。

Effects of Moderate sedation on immunity Function in Patients with AECOPD

Objective To Investigate the effects of moderate sedation treatment on immunity function in AECOPD patients receiving mechanical ventilation.Methods Fifty nine patients of AECOPD receiving mechanical ventilation were randomly divided into two groups: traditional sedation group(Group A) of 28 patients and moderate sedation group(Group B) of 31 patients.Group A received normal loading dose of Fentanyl and Midazolam,which was followed by continuous intravenous pump injection;Group B received the same medication as Group A,however,the subsequent treatment adopted a strategy of procedural sedation and daily awakening.During sedation process,patients in both groups were observed the changes of blood pressure,heart rate,and air passage peak pressure;immunity function index prior to treatment and at the seventh day of treatment were measured including peripheral blood serum IgG,IgA,IgM,CD3,CD4/CD8,HLA-DR;other index including CRP,TNF and IL-8 were also measured.Results Group A displayed higher occurrence rate than Group B in terms of fluctuation in dysphoria,blood pressure,heart rate,respiration,and air passage peak pressure(P<0.01);Group B patients had elevated levels of IgA,IgG,HLA-DR and CD4/CD8 after treatment,which were higher than those prior to treatment and Group A(P<0.05);The levels of CRP,TNF and IL-8 for both groups were lower than those prior to treatment(P<0.05);However,Group B had decreased levels of TNF and IL-8 with a statistical difference from those prior to treatment(P<0.01) and Group A(P<0.05).Conclusion The treatment of moderate sedation can play a regulating role in immunity function and inflammatory reaction.