The Study Correlation Nutrition-immune Status And Ventilator-associated Pneumonia With Critically Ill Patients

Objective To study dynamically the clinical index of nutrition-immune in the patients who was ventilated mechanically, and explore the correlation between the nutrition-immune status and Ventilator-associated pneumonia and the mechanisms.Methods A prospective and controlled study was performed.Preliminary Screening 156 patients who received mechanical ventilation in the Intensive Care Unit of Affiliated Hospital of Ningxia Medical University from November,2009 to May,2010 as our objects of study.Finally,58 patients were slected as our objects of study according to the criterions strictly. To study dynamically the levels of prealbumin,albumin,transferrin,cholinesterase,total lymphocyte count,high sensitivity C-reactive protein and white cell counts at the first day,MV 48 hours,MV 96 hours and MV 1W; and detect the levels of Leptin, the ratio of CD4 ~+ T cell and CD8 ~+T cell at the first day,MV 48 hours and MV 1W; to the patients,chest x-ray film and pathogen culture were respectively detected at the first day,MV48 hours,MV96 hours and MV 1W,make the scores of APACHEⅡ,SOFA and CPIS in four different time points to the patients. According to the diagnostic criteria of VAP at 1 week and in one weeks, the patients were divided into the group VAP and NVAP.15 normal persons were chosed as the baseline control. Nutrition-immune status,inflammatory index and the clinical score index were compared between the group VAP and NVAP by statistical methods of one- way ANOVA,repeated measurement analysis of variance,two-samples t-test,Chi-square test and regression analysis to study the function in the occurrence of VAP.Results In the level of leptin, there is no difference among the group VAP, NVAP and controls at baseline level.The level of leptin after 48 hours and 1W in the group VAP is higher than the group NVAP. The total lymphocyte count,high sensitivity C-reactive protein and white cell counts after 96 hours and 1W in the group VAP is higher than the group NVAP. The CD8~+T lymphocyte proportion after 1W in the group VAP is higher than the group NVAP. The serum prealbumin after 48 hours and serum transferring after 1w in the group VAP is higher than the group NVAP. The scores of APACHEⅡ,SOFA and CPIS after 96hours and 1w in the group VAP are higher than the group NVAP.Conclusion Nutritional Status and immune function are significantly correlative with the occurrence of VAP. The correlation between nutritional status and VAP is associated with the half-life of nutritional index, and the relativity between immune function and the occurrence of VAP is related with the balance adjustment of leptin to CD4 ~+ / CD8 ~+. Leptin as a immune adjustment factors and malnutrition can make the patients'immune function low or in immunosuppression states, causing the VAP in the patients with mechanical ventilation .