心脏术后体外膜肺氧合支持患者的呼吸道感染现状及其对机体免疫功能的影响

doi:10.3969/j.issn.1671-7171.2018.06.026

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

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12 h、24 h及36 h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】本组共分离病原菌32株,其中革兰阴性杆菌21例(65.63%),革兰阳性球菌7例(21.88%),真菌4例(12.50%)。治疗后12 h、24 h、36 h患者血清IgA、IgM、IgG水平均低于治疗前,且治疗后12 h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12 h、24 h、36 h患者CD3⁺、CD4⁺、CD8⁺水平均较治疗前有所下降,且治疗12 h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12 h、24 h、36 h患者血浆ANP、BNP、NT-proBN水平均较治疗前有所下降,且治疗后12 h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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

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

Abstract：【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 atrial 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 treatment, the levels of CD3⁺, CD4⁺ and CD8⁺ in the patients were all decreased compared with those before treatment. 12 hours of treatment, the levels of CD3⁺ CD4⁺ and CD 8⁺ decreased to the lowest point, and then gradually 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 treatment, and the levels of ANP,BNP,NT-proBN in plasma decreased to the lowest level 12 hours after treatment, but were still significantly lower than those before treatment, the difference was statistically significant (P<0.05).【Conclusion】 The incidence of respiratory tract infection in patients with extracorporeal membrane oxygenation support after cardiac surgery is high. It can inhibit the immune function and plasma ANP、BNP and NT-proBNP level of patients.

Key words： CardiacSurgicalProcedures ExtracorporealMembraneOxygenation RespiratoryTractInfections Immunoassay

收稿日期: 2018-05-25

PACS:

R654.2

通讯作者: E-mail:zhaoxin1108@126.com

引用本文:

张鹏宇, 汤楚中, 潘绪, 迟海涛, 孙文婷, 王志坚. 心脏术后体外膜肺氧合支持患者的呼吸道感染现状及其对机体免疫功能的影响[J]. 医学临床研究, 2018, 35(6): 1120-1123.
ZHANG Peng-yu, TANG Chuzhong, PAN Xu, et al. Status of Respiratory Tract Infection in Patients with Extracorporeal Membrane Oxygenation (ECMO) after Cardiac Surgery and its Effect on Immune Function. JOURNAL OF CLINICAL RESEARCH, 2018, 35(6): 1120-1123.

链接本文:

http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.06.026 或 http://www.jcr.net.cn/CN/Y2018/V35/I6/1120

[1] 卢安东, 郭剑, 苗莉霞,等. 心脏术后体外膜肺氧合支持临床应用探讨[J].中国体外循环杂志, 2017, 15(2):100-104.
[2] 曾敏, 王旭. 82例儿童心脏术后患者体外膜肺氧合(ECMO)支持治疗的临床结果分析[J].中国循环杂志, 2015,16(3):108-109.
[3] 高国栋, 龙村, 胡强,等. 体外膜肺氧合支持治疗期间机体凝血功能的动态变化[J].实用临床医药杂志, 2015, 19(9):9-11.
[4] 谢海秀, 杨峰, 江春景,等. 成人心脏术后心源性休克接受体外膜肺氧合循环辅助脱机后临床转归分析[J].中华医学杂志, 2017, 97(12):929-933.
[5] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J].中华医学杂志, 2001, 81(5):314-320.
[6] 蒋张, 肖立琼, 杨婷,等. 心脏移植术后右心功能不全行体外膜肺氧合治疗1例的护理体会[J].岭南心血管病杂志, 2016, 22(3):344-346.
[7] 刘颖悦, 洪小杨, 周更须,等. 体外膜肺氧合在儿童先天性心脏病术后心功能衰竭救治中的应用[J].中国体外循环杂志, 2016, 14(1):42-45.
[8] 焦瑞, 江春景, 侯晓彤,等. 体外膜肺氧合在主动脉手术后应用的院内死亡危险因素分析[J].中华胸心血管外科杂志, 2017, 33(6):41-45.
[9] 周晔, 李呈龙, 王晓存,等. 体外膜肺氧合辅助患者医院感染病原菌分布与耐药性分析[J].中华医院感染学杂志, 2015,41(22):5097-5099.
[10] Welp H, Scherer M, Martens S,et al. Infections occurring during extracorporeal membrane oxygenation use in adult patients for postcardiotomy heart failure[J].Thorac Cardiovasc Surg,2016, 64(1):435-437.
[11] Kim GS, Lee KS, Park CK, et al. Nosocomial infection in adult patients undergoing veno-arterial extracorporeal membrane oxygenation[J].J Korean Med Sci,2017, 32(4):593.
[12] Prodhan P, Gossett JM, Rycus PT, et al. Extracorporeal membrane oxygenation in children with heart disease and del22q11 syndrome: a review of the Extracorporeal Life Support Organization Registry[J].Perfusion,2015, 30(8):660-665.
[13] Polito A, Barrett CS, Rycus PT, et al. Neurologic Injury in Neonates with Congenital Heart Disease During Extracorporeal Membrane Oxygenation: An Analysis of ELSO Registry Data[J].ASAIO J,2015, 61(1):43.
[14] 高国栋, 龙村, 胡强,等. 体外膜肺氧合支持治疗中炎性因子变化的意义[J].心肺血管病杂志, 2015, 34(4):270-273.
[15] 朱瑞秋, 刘长智, 卢剑海,等. 体外膜肺氧合治疗难治性心源性休克的临床疗效及其影响因素[J].中华心血管病杂志, 2016, 44(9):777-781.
[16] 孙春雷, 周跃. 体外膜肺氧合对严重心力衰竭患者血浆ANP、BNP、NT-pro BNP水平的影响[J].浙江医学, 2015, 37(24):2007-2009.
[17] Allencherril J, Birnbaum I. Heart failure in thyrotoxic cardiomopathy: extracorporeal membrane oxygenation treatment for graves' disease[J].J Extra Corpor Technol,2015, 47(4):231-232.