免疫球蛋白对脓毒症患者血管内皮功能影响.pdfVIP

免疫球蛋白对脓毒症患者血管内皮功能的影响 王勇强，窦琳,曹书华,李建 作 者： 王勇强 硕士研究生导师 主 窦 琳 硕士研究生 主治医师 曹书华 博士研究生导师 主任医师 高虹 副主任医师 作者单位:天津市第一中心医院急救医学研究所ICU病房， 邮 编：300192 E-mail:doulint@ 电 话 正文字数:2823，表数 4 【摘要】目的：探讨静脉注射用人血免疫球蛋白(Intravenous Immunogiobulin ，IVIg ) 对脓毒症相关性血小板减少症的辅助治疗作用。方法：将60例出现血小板减少的脓 毒症患者分成两组，治疗组在综合治疗的基础上加用IVIg,观察IVIg对患者血管内 皮功能、血小板计数，出血倾向的影响。结果：治疗组血小板计数在治疗后第3天 开始明显高于对照组，出血发生率低于对照组；APACHE III评分在治疗后第3天、 血TM、VWF水平及在治疗后5天较对照组明显下降（P0.05）。结论：采用IVIg治疗 脓毒症相关血小板减少症，可减轻患者血管内皮细胞损伤,使血小板计数迅速上升， 改善患者的出血倾向。 关键词：免疫球蛋白，脓毒症，血小板减少症，血管内皮 The effect of treatment with immunoglobulin to endothelial function and blood platelet count of sepsis Resurch institute of critical care medicine,Tianjin First Center hospital.TianJin 300192.China Abstract Objective:To investigate the effects of Intravenous Immunogiobulin therapy of Thrombocytopenia Associated sepsis.Methods: 60 septic thrombocytopeniac patients were devided into IVIG group and control group,30 cases respectively. IVIG was intravenously injected together with conventional treatment for IVIg group 400mg/(kg.d) for 5 days.Before and after IVIG treatment,Platelet(PLT) counts, TM, VWF level and APACHEIII were measured.Results:Platelet counts were increased after IVIG treatment by day 3 in the IVIg group(P0.05).The morbidity of bleeding episode were significantly reduced, APACHEIII were reduced on day 3 , TM and VWF level were reduced on day 5(P0.05).Conclusions: The use of IVIg to treat septic thrombocytopenia leads to a more rapid and greater increase in platelet count and significantly reduce the morbidity of bleeding episode and TM and VWF level and APACHE III. Key words:immunoglobulin,sepsis,thrombocytopenia` 近年研究发现35-59% 的脓毒症病人可以发生血小板减少，而血小板进行性下降往往提 （1） 示病人存在严重的脓毒症且预后