Surgical Department Critically Ill Sepsis Patient Immunity Function Change And Clinical Significance

[Objective] Through monitor sepsis patient organism immunity target change, more objective appraisal it to sepsis patient prognosis prospective value.[Methods] Selects 21 example critically ill sepsis, the infectious shock patient decides as sepsis group; Selects 21 example significant surgery patient to decide as the serious wound group.Sepsis group survives again according to the patient or not divides into the survival group and the death group.All patients separately after the technique first day and fourth day extraction venous blood 1mL, with flow the type cell instrumental measurement fate to analyze T lymphocyte subgroup CD3, CD4, CD8, HLA-DR, CD4/CD8, the recording life symptom and the remedial measure, to carries on APACHE on the patientⅡGrading, the SOFA grading, serious degree grading, after determines the patient to enter in front of SICU and enters the technique the routine blood test lymphocyte number, counts the patient machinery ventilation the time, SICU enters the time, the extension turns over to the situation, and with T lymphocyte subgroup HLA-DR, CD4/CD8 and these targets makes the relevant analysis, makes the relevant analysis with the T lymphocyte subgroup with three kind of grading.[Results] Sepsis group does not have the remarkable difference with the serious wound group in the age and the sex, but Sepsis group lives the SICU time and the machinery ventilation time all excels in the serious wound group, the case fatality rate also obviously is higher than the serious wound group.Sepsis group the first day T lymphocyte subgroup various values difference is not big after the serious wound group technique, but fourth days compare with the serious wound group besides CD8 other various values remarkable somewhat low.After Sepsis group CD3, CD4, the CD8 technique fourth days compare the first day difference not to be obvious, but CD4/CD8 and HLA-DR then slightly high; After serious wound group CD3, CD4, HLA-DR, the CD4/CD8 technique fourth days compare the first day obvious ascension, CD8 two days quite obvious reduce.But after Sepsis death group and the survival group technique the first day T lymphocyte subgroup various values compare the difference not greatly fourth day survival group CD3, CD4, CD4/CD8 and HLA-DR and the death group compare have the obvious ascension, two group of between CD8 changes are not big.After the death group technique fourth days compare first day CD3, CD4 reduce obviously, CD8, CD4/CD8 and HLA-DR but although also present reduce the tendency the difference not to have the significance; After the survival group technique fourth days compare first day CD3, CD4, CD4/CD8 and HLA-DR appear the obvious ascension, but the CD8 value compares the first day change not to be obvious.Sepsis group first day compares in front of the technique after the serious wound group circumference blood lymphocyte technique to appear reduces obviously, after but afterwards Sepsis group lymphocyte technique sixth days compare with first day have the slight rise the difference not to have the significance; But serious wound group lymphocyte performance for obvious ascension.Sepsis group APACHE II Grading, the SOFA grading, the MODS grading appears reduces the tendency, after the technique first day compares the difference with sixth days not to have the significance, after serious wound group technique sixth day APACHE II But grading compares first day to have reduces the tendency the difference not to have the significance, after the SOFA grading, the MODS grading technique sixth days compares first day to reduce obviously; Sepsis death group APACHE II Grading, the SOFA grading, the MODS grading presents not the big change, but Sepsis survival group then but for reduces the performance the difference not to have the significance.HLA-DR, CD4/CD8 and SICU enter the time and the machinery ventilation time assume the inverse correlation.CD3, CD4, CD4/CD8, HLA-DR and the first day APACHE II grading, the SOFA grading, the MODS grading assumes the inverse correlation. [Conclusion]①Sepsis patient T lymphocyte subgroup CD3, CD4, CD8, CD4/CD8 and HLA-DR are getting up sickness initial period namely to appear reduce also maintain continuously continually in the low horizontal position, reduces along with the condition aggravation T lymphocyte subgroup obviously, displays for the long-term immunity paralysis.②The serious wound patient initial period also appears T lymphocyte subgroup CD3, CD4, CD8, CD4/CD8 and the HLA-DR drop, but has the tendency along with the condition change for the better which restores to the normal value, only has the short immunosuppression condition.③Sepsis patient is consistent with the serious wound patient circumference blood lymphocyte quantity change with the T lymphocyte subgroup.④The T lymphocyte subgroup monitor has the good prospective value to the patient prognosis, continues to reduce prompts the prognosis not to be good.⑤The circumference blood lymphocyte quantity continuous monitoring also has the good forecast significance to the patient prognosis, also the monitor method is easy and feasible.⑥T lymphocyte subgroup and circumference blood lymphocyte quantity and APACHEⅡGrading, the SOFA grading, the MODS grading assumes the inverse correlation, also may take the appraisal condition serious degree the target.