痰热清注射液对呼吸机相关性肺炎患者免疫因子和临床预后的影响研究

目的:研究痰热清注射液对呼吸机相关性肺炎(VAP)患者免疫因子和临床预后的影响。方法:155例VAP患者随机分为治疗组和对照组,治疗前和治疗后第1、3、5、7天检测血清CRP、IL-6、TNF-α的动态变化;比较治疗前和治疗后第3天X线胸片变化;统计机械通气(MV)时间、脱机成功率和死亡率。结果:155例VAP患者治疗前血清CRP、IL-6、TNF-α较正常水平均明显升高;治疗组在治疗后第5天血清IL-6、TNF-α水平较对照组开始显著下降(P<0.05);在第7天血清CRP、IL-6、TNF-α水平均较对照组显著下降(P<0.05));治疗组MV时间较对照组显著缩短(P<0.05);治疗组3d后X线胸片改善率、首次脱机成功率均显著高于对照组(P<0.05),死亡率显著低于对照组(P<0.05)。治疗组在治疗后第7天血清CRP、IL-6和TNF-α与MV时间呈正相关。结论:痰热清注射液在辅助治疗VAP中,通过抑制过度的炎症反应,恢复部分机体免疫功能,有助于减弱VAP后继发多脏器功能损害,从而缩短MV时间,降低死亡率,改善VAP预后。

Effects of Tanreqing Injection on Immune Factors and Clinical Outcome in Patients with Ventilator Associated Pneumonia

OBJECTIVE： To observe the effects of Tanreqing injection on the immune factors and clinical outcome in patients with ventilator associated pneumonia （VAP） . METHODS： 155 patients with VAP were randomly divided into trial group and control group. Serum levels of CRP, IL- 6 and TNF- α were determined at 0, 1, 3, 5 and 7 days after treatment. The chest X- ray results at 0 and 3 days after treatment were compared. The mechanical ventilation （MV） time and the successful rate of weaning from mechanical ventilation and the mortality rate were recorded. RESULTS： The serum levels of CRP, IL- 6 and TNF - α in all 155 VAP patients were significantly higher than normal levels, at 5 days, serum levels of IL-6 and TNF a in the trial group began to decrease significantly as compared with the control group（P〈0.05）, on day 7, serum levels of CRP, IL- 6 and TNF-α were significantly lower than in the control group（P 〈 0.05）, and the MV time in the trial group was significantly shorter than in the control group（P 〈 0.05） .The improvement rate of chest X - ray results at 3 days and the successful rate of weaning from mechanical ventilation in the trial group were all significantly higher than in the control group （P（0.05）, but the mortality rate of trial group was significantly lower than in control group （P〈0.05） . Levels of CRP, IL - 6 and TNF-a on day 7 were positively correlated with the MV time. CONCLUSION： As an adjunctive therapy for VAP, Tanreqing injection can attenuate the functional lesion of multi- organs secondary to VAP by suppressing excessive inflammatory reaction and facilitate partial recovery of immune function so as to shorten MV time, lower mortality and improve the clinical outcome of VAP.