摘要
目的 探讨严重创伤患者血清中性粒细胞黏附分子CD11b、血清可溶性细胞间黏附分子 1(sICAM 1)的动态变化及乳酸林格氏液 (LR)、 7 5 %氯化钠 (7 5 %HTS)和 2 0 %白蛋白 (2 0 %Albumin)的治疗作用。方法 6 0例严重创伤患者 (ISS计分 16 4 1分 )分为ISS≤ 2 5组和ISS >2 5组 (均再分为LR、HTS和Albumin组 )。分别采用流式细胞仪和ELISA法测定CD11b及sICAM 1表达。结果 ①创伤 4h后各处理组CD11b、s ICAM 1显著升高 (P <0 0 5 ) ;12～ 4 8hISS >2 5组各点均较ISS≤ 2 5组显著增高 (P <0 0 5 ) ;② 2 4～ 4 8hHTS组和Albumin组较LR组明显低 (P <0 0 5 ) ;③ISS >2 5组患者MODS发生率及病死率较ISS≤ 2 5组高 (P =0 0 1,P =0 0 6 ) ;HTS和Albumin组MODS发生率及病死率较LR组低 (P =0 0 5 ,P =0 0 6 )。结论 严重创伤时 ,PMNCD11b及sICAM 1表达增加 ,并与病情轻重相关 ;采用 7 5 %氯化钠及 2 0 %白蛋白复苏时CD11b和sICAM 1表达值及MODS发生率。
Objective To investigate the changes of polymorphnuclear neutrophil(PMN)adhesion molecule CD11b and serum soluble ICAM-1(sICAM-1),and therapeutic effects of Lactated Ringers,7.5%HTS and 20%Albumin on severely injured patients.Methods Sixty severely injured patients(ISS score 16 to 41)were divided into group with ISS≤25 and group with ISS>25 groups.Each group was subdivided into LR,HTS and Albumin groups.CD11b and sICAM-1 were measured by using flow cytometry and ELISA,respectively.Results PMN CD11b and sICAM-1 were elevated 4 hours after trauma in all experimental groups(P<0.05),CD11b and SICAM-1 were higher in the ISS> group than in ISS≤25 group from 12 to 48 hours after trauma(P<0.05),but were significantly lower in the HTS and Albumin groups than in the LR group from 24 to 48 hours(P<0.05).The incidence of MODS and mortality in the ISS > group was higher than in the ISS≤25 group,and lower in the Albumin and HTS groups than LR group(P<0.05).Conclusion PMN CD11b and sICAM-1 expression,which may vary,depending on the type of resuscitation fluids used,are increased in severely injured patients and are related with the severity of trauma.Among the studied fluids,20% Albumin and 7.5% HTS can lead to lower expression of CD11b and sICAM-1,and lower incidence rate of MODS and mortality than using Lactated Ringers alone.
出处
《中华急诊医学杂志》
CAS
CSCD
2004年第11期751-754,共4页
Chinese Journal of Emergency Medicine
