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| Effect of fluid resuscitation guided by severe ultrasound on inflammatory factors and immune function in patients with septic shock |
| Yao Li-li, Ma Yong-feng, Jia Li-jing, Duan Xi-jie, Zhang Li, Zhang Ting-ting, Zhang Hao |
| Intensive Care Unit, Cangzhou People′s Hospital, Cangzhou 061000, China |
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Abstract Objective To observe and analyze the effect of fluid resuscitation on inflammatory factors and immune function in patients with septic shock under the guidance of severe ultrasound, and to provide a theoretical basis for clinical treatment. Methods From July 2014 to February 2018, 152 septic shock patients were selected which were randomly divided into the observation group (76 cases) and the control group (76 cases) . The observation group received fluid resuscitation under the guidance of severe ultrasound, while the control group received routine fluid resuscitation. The patients′hospitalization time, ICU time, mechanical ventilation time, 28 d mortality and changes of tissue perfusion index (MAP, CVP, ScvO2) before and after treatment were observed. The levels of serum inflammatory factors (TNF-α, IL-1β, IL-6, IL-10) and immune function (CD4+, CD8+, IgA, IgG) were compared before and after treatment with 6 h, 24 h and 72 h. Results The hospitalization time, ICU time, mechanical ventilation time and 28 d mortality of the patients in the observation group were significantly lower than those of in the control group ［（21.82±6.36）d vs.（24.13±7.11）d，t=2.111，P=0.036；（153.25±28.16）h vs. （217.07±34.22）h，t=12.554，P＜0.001；（21.68±5.31）h vs. （32.81±6.55）h，t=11.607，P＜0.001；3.95%（3/76）vs. 13.16%（10/76），χ2=4.122，P=0.042］. There were no significant difference in the level of tissue perfusion index (MAP, CVP, ScvO2), inflammatory factors (TNF-α, IL-1β, IL-6, IL-10) and immune function (CD4+, CD8+, IgA, IgG) in the two groups before the treatment (P>0.05). After treatment, the MAP, CVP and ScvO2 levels of the observation group were higher than those of in the control group ［（75.89±11.36）mm Hg vs. （72.10±10.98）mm Hg，t=2.091，P=0.038；（10.51±2.03）mm Hg vs. （9.08±2.52）mm Hg，t=3.852，P=0.002；（78.27±5.17）% vs. （75.62±5.02）%，t=3.206，P=0.002］. The serum levels of TNF-α, IL-1β, IL-6, IL-10 in the treatment group of 24 h and 72 h were significantly lower than those in the control group ［pg/mL（TNF-α：209.31±27.02 vs. 257.03±25.98，t=11.098，P＜0.001；106.32±17.69 vs. 152.13±19.08，t=15.349，P＜0.001）；（IL-1β：72.33±16.83 vs. 79.95±17.06，t=2.772，P=0.006；45.96±14.03 vs. 51.33±15.31，t=2.254，P=0.026）；（IL-6：126.34±23.48 vs. 149.87±25.06，t=5.973，P＜0.001；80.65±18.93 vs. 105.20±20.33，t=7.705，P＜0.001）；（IL-10:40.11±14.03 vs. 45.30±13.64，t=2.312，P=0.022；31.25±10.15 vs. 38.46±10.86，t=4.228，P＜0.001）］, but the levels of CD4+, IgA and IgG were higher than those in the control group ［CD4+(%)：34.95±6.87 vs. 31.88±7.16，t=2.697，P=0.008；43.01±7.22 vs. 38.26±7.60，t=3.950，P＜0.001. IgA(g/L）：1.70±0.36 vs. 1.56±0.27，t=2.712，P=0.008；1.93±0.49 vs. 1.77±0.38，t=2.249，P=0.026）. IgG（g/L）：7.66±1.29 vs.7.10±1.38，t=2.584，P=0.011；8.99±1.47 vs. 8.50±1.39，t=2.111，P=0.036］. Conclusion The patients with septic shock under the guidance of severe ultrasound to resuscitation fluid, patients′ hospitalization time, the time of ICU, the time of mechanical ventilation and the mortality of 28 d could be significantly reduced, and the tissue perfusion is improved.The inflammatory factors could be alleviated and the immune function is improved.
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Corresponding Authors:
Ma Yong-feng, E-mail：yongfeng80@163.com
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