【摘要】 目的：探讨右美托咪定（Dex）对老年脓毒症机械通气患者炎症和预后的影响。方法：回顾性分析2015年9月—2019年8月天津医科大学总医院老年重症监护室收治的64例脓毒症需机械通气治疗患者的临床资料，分为常规治疗+Dex组（Dex组，36例）和常规治疗组（28例）。收集两组基础信息，包括年龄、性别、入住ICU时急性生理学及慢性健康状况评分系统评分（APACHEⅡ评分）和序贯器官衰竭评分（SOFA评分）、机械通气时间、入住ICU时间、基础病、感染部位；治疗前和治疗后第3、7天外周血T细胞亚群比例（CD4+T、CD8+T、CD4+T/CD8+T）及各自凋亡率（CD4+T、CD8+T），细胞因子[白细胞介素（IL）-6、IL-10、肿瘤坏死因子（TNF）-α）]水平；计算入住ICU期间多器官功能障碍综合征（MODS）发生率和病死率，并对两组入住ICU期间28 d存活状况进行生存分析。结果：两组性别、年龄、APACHEⅡ评分、SOFA评分、机械通气时间、ICU住院时间、基础病、感染部位差异均无统计学意义（均P>0.05）。两组治疗后第7天CD4+T细胞比例、CD4+/CD8+较治疗前升高，且Dex组高于常规治疗组，而CD4+T细胞凋亡率较治疗前降低，且Dex组低于常规治疗组（t=2.670、1.960、-1.984，均P<0.05）。两组TNF-α、IL-6水平总体呈下降趋势，第7天TNF-α、IL-6水平较治疗前降低明显，且Dex组低于常规治疗组（t=-2.159、-2.382，均P<0.05）。两组入住ICU期间MODS发生率（χ2=0.638）和病死率（χ2=0.145）差异均无统计学意义（均P>0.05）；然而Dex组28 d生存率高于常规治疗组（Log-rank=4.099,P<0.05）。结论：Dex可能调节老年脓毒症机械通气患者T淋巴细胞亚群比例，降低炎症指标水平，提高入住ICU期间28 d生存率，从而改善预后。更多还原

【Abstract】 Objective:To investigate the effect of dexmedetomidine(Dex)on inflammation and prognosis in elderly patients with sepsis requiring mechanical ventilation. Methods:The clinical data of 64 eligible patients with sepsis requiring mechanical ventilation in the Elderly ICU of the General Hospital of Tianjin Medical University from September 2015 to August 2019 were retrospectively reviewed.They were divided into routine treatment+Dex group(Dex group,36 cases)and routine treatment group(28 cases). The collected information included demographic characteristics,acute physiology and chronic health evaluation(APACHE Ⅱscore)and sequential organ failure assessment(SOFA score)at admission of ICU,mechanical ventilation time,ICU length of stay,medical comorbidities,site of infection,proportion of T cell subsets(CD4+T,CD8+T),ratio of CD4+to CD8+,apoptotic rates(CD4+T,CD8+T),cytokine levels(IL-6,IL-10,and TNF-α)before treatment and on the 3rd and 7th days after treatment. The occurrence and mortality of multiple organ dysfunction syndrome(MODS)during ICU admission were calculated,and the 28-day survival status of the two groups during the ICU stay was analyzed. Results:There were no significant differences between the two groups with respect to age,sex,APACHE Ⅱ score,SOFA score,mechanical ventilation time,ICU length of stay,underlying disease,site of infection(all P>0.05). The proportion of CD4+T cells and CD4+/CD8+on the 7th day after treatment increased compared with that before treatment,and the Dex group was higher than the control group,while the apoptotic rate of CD4+T cells decreased compared with that before treatment,and the Dex group was lower than the control group(t=2.670,1.960,-1.984,all P<0.05). In general,the levels of TNF-α and IL-6 in the two groups showed a downward trend,TNF-α and IL-6 levels on the 7th day after treatment decreased significantly compared with those before treatment,and the Dex group was lower than the control group(t=2.159,-2.382,both P<0.05). The incidence of MODS（χ2=0.638）and mortality（χ2=0.145）were not statistically significant during the ICU stay(both P>0.05). However,the 28-day survival rate of patients in the Dex group was higher than that in the control group(Log-rank=4.099,P<0.05). Conclusion:Dex may adjust the proportion of T lymphocyte subsets in elderly patients with sepsis requiring mechanical ventilation,reduce the level of inflammatory indicators,and increase the 28-day survival rate during the ICU stay,thereby improve the prognosis.更多还原