ABSTRACT
Objective To evaluate the value of PLR-△SVV for the septic shock patients with autonomous breathing. Methods 60 patients were included in the study. Hemodynamic data of PICCO were collected before and after treatment. After rehydration, the group (△SV≥10%) was defined volume responder group, and then the predictive value of PLR-△SVV was analyzed. Results Compared with the nonresponders group, PLR-△SVV was increased significantly in response group[(10 ± 4)mL vs (14 ± 6)mL,P<0.05]. The ROC curve for PLR-△SVV were 0.881, and the sensitivity was 85.7%, the specificity was 92.0%. Conclusion PLR-△SVV can be used to predict fluid responsiveness for septic shock patients with spontaneously breathing.
ABSTRACT
Objective To explore the influence of ulinastatin combined with thymic peptide?1on the polarization of T helper(Th) cells,and the immunoregulatory effects on septic patients.Methods Clinical data of 60septic patients admitted to intensive care unit (ICU)of Guangzhou General Hospital of Guangzhou Command from Jun.2006to Oct.2007were collected and randomly divided into treatment group(n=30)and control group(n=30).The control group received classic SSC treatment,while the treatment group was given classical SSC treatment plus ulinastatin and thymic peptide?1.The control group was divided again into death subgroup and survival subgroup according to the living state on day 28.Peripheral blood samples were collected at day 1(before administration)and day 10. CD4+ T cell subset was detected by flow cytometry,and the levels of IFN-?(T helper type-1cytokine)and IL-4(T helper type-2 cytokine)were evaluated semi-quantitatively.Ten healthy volunteers were chosen in the meantime as healthy controls.Results The positive rates of IFN-?and IL-4of CD4+ T cells declined significantly at day 10in treatment group compared with those in control group and before treatment(P0.05).The IFN-?positive rate presented a low level and showed a downward trend after treatment in survival subgroup,while presented a high level and also showed a downward trend after treatment in death subgroup.The IL-4positive rate showed a downward trend in survival subgroup and upward trend in death subgroup.Conclusion Ulinastatin combined with thymic peptide?1may improve the proportion imbalance of IFN-?and IL-4of septic patients,and regulate the immune status.
ABSTRACT
Objective To analyze the immune state and discuss the effects of immunoregulation therapy of combined use of ulinastatin and thymosin ?1 in the treatment of posttraumatic sepsis. Methods Forty-eight patients with posttraumatic sepsis admitted to ICU during Oct. 2005 to Oct. 2007 were included and randomly divided into treatment group and control group (24 each). Patients in control group received conventional SSC treatment, while those in treatment group received conventional SSC treatment plus immunoregulation therapy with a combination of ulinastatin and thymosin ?1. Peripheral blood CD14+ monocyte HLA-DR expression was detected by flow cytometry to determine the innate immunity of posttraumatic septic patients on day 1, 5, 7 and 28 (or death), and serum levels of IL-6 and IL-10 were assessed by ELISA to evaluate the nonspecific immunity at day 1 and 28 (or death). APACHE Ⅱ scores were recorded on day 1, 5, 7 and 28 (or dearth). Ten healthy volunteers were enrolled as healthy controls. Results At admission the expression of CD14+ monocyte HLA-DR was lower than 30% in 9 posttraumatic septic patients. The expression levels of CD14+ monocyte HLA-DR in the patients in treatment group were much higher than those in control group (P0.05). Before treatment, no significant difference existed in APACHE Ⅱ scores between treatment group and control group, while this score in the patients in treatment group was much lower than that in control group on day 5, 7 and 28 (P0.05). Conclusions There is immunosuppression in some posttraumatic patients with somplication of sepsis. All these patients manifest exaggerated nonspecific immunity at the early stage, and then manifest immunodepression as sepsis progresses. The immunoregulation effects of a combination of ulinastatin and thymosin may facilitate the balance of pro-inflammatory and anti-inflammatory media, thus ameliorating septic symptoms. No improvement in 28 day mortality has been seen, probably due to limited number of patients in present study.