目的:调查我国急危重症医护人员对镇静镇痛指南和规范的认知情况，为进一步采取措施提供依据。方法:2018年6月26日在全国116家综合性医院的EICU和ICU，针对医生和护士开展横断面多中心调查。参照指南制定认知状况调查表，采用电子版在线方式填写，内容涉及ICU镇静镇痛治疗的主要原则和知识。结果:最终共2 615名医护人员参与调查并纳入分析。116家医院包括三甲105家（90.5%），三乙9家（7.8%），二甲2家（1.7%）。2 615名医护人员中，医生与护士比例为38.6% vs 61.4%，男女比例为31.2% vs 68.8%，职称（初/中/高级）和科室（EICU/ICU）构成比为56.9% vs 33.4% vs 9.7%和77.7% vs 22.3%。其中80.6%的调查对象所在科室具有镇静镇痛的标准流程，89.2%的调查对象对结果进行记录，评估记录间隔时间为4（1, 4）h。约80%医护人员对镇静镇痛指南较熟悉，且按照指南进行实践。但对于镇痛的原则、镇静深度的选择、谵妄的处理原则和每日唤醒等的认知尚有不足。 结论:本次调查范围内的大部分急危重症医护人员对镇静镇痛指南较熟悉且能按照指南实践，但尚有一些不足，有待进一步培训学习。

在城市历史街区经济发展与空间演变的过程中,文化创意产业的进入为城市更新与历史街区的转型提供了新思路.研究使用定性系统动力学方法,通过质性数据构建因果循环图,对珠海北山社区的空间再生产过程进行分析,最终得到由5个正反馈回路与1个负反馈回路构成的空间生产动力机制,并得出以下结论:①政府对城中村的规划改造与居民的空间让渡是北山空间再生产的开端;②文化企业家的进入创造了新的空间主体与社会关系,对历史建筑空间进行了更新与再利用,打造了新兴文化创意空间;③游客的多元化旅游感知与媒体传播对北山进行了信息再生产;④空间主体的多元化构建了北山多重属性相互交融的空间,复杂并趋于稳定,各个利益主体在博弈与妥协中达到相对平衡.在回路分析的基础上,研究将"资本三重循环"理论与系统动力学模型相结合对北山社区的空间再生产机制进行了深入探讨.本研究为历史街区的发展转型机制提供具有系统预见性的新工具,并为新型城镇化建设的发展建设提供参考.

目的:调查我国EICU/ICU危重患者镇静镇痛实施状况，为镇静镇痛规范化实施提供改进依据。方法:2018年6月26日在全国116家综合性医院EICU/ICU内纳入年龄大于18周岁的患者，收集患者一般信息，评估镇静镇痛指征，筛选"需要镇静/镇痛治疗组"，进一步收集该组患者实际镇静镇痛信息，最后比较镇静/镇痛合理性及达标情况。结果:⑴最终共116家医院1 195例患者纳入研究并分析，116家医院包括三甲105家（90.5%），三乙9家（7.8%），二甲2家（1.7%）。1 195例患者中位年龄65（49，78）岁，男性769例（64.4%），女性426例（35.6%），APACHE Ⅱ评分16（10，22）分。⑵机械通气536例，已镇静未达标166例（31.0%），需镇静未实施29例（5.4%），镇静不合理占36.4%（195/536）；非机械通气659例，已镇静未达标36例（5.5%），需镇静未实施35例（5.3%），镇静不合理占10.8%（71/659）。14.0%的机械通气和15.9%的非机械通气患者未使用镇静评估工具。已实施镇静的341例患者，机械通气患者达标率为40.3%（112/278），非机械通气患者达标率42.9%（27/63）。⑶清醒患者760例，已镇痛未达标133例（17.5%），需镇痛未实施24例（3.2%），镇痛不合理占20.7%（157/760）；非清醒患者435例，已镇痛未达标85例（19.6%），需镇痛未实施27例（6.2%），镇痛不合理占25.7%（112/435）。17.9%的清醒患者和13.3%的非清醒患者未使用镇痛评估工具。已实施镇痛的345例患者，清醒患者达标率为25.7%（46/179），非清醒患者达标率为48.8%（81/166）。⑷73例患者（6.1%）发生谵妄，谵妄评估工具使用率为35.3%。结论:本次调查范围内的EICU/ICU镇静镇痛实施状况并不理想，有必要对医护人员进行镇静镇痛规范化培训，进一步规范镇静镇痛实施状况。

In this study, we collected a total of 610 hospitalized patients from Wuhan between February 2, 2020, and February 17, 2020. We reported a potentially high false negative rate of real-time reverse-transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 in the 610 hospitalized patients clinically diagnosed with COVID-19 during the 2019 outbreak. We also found that the RT-PCR results from several tests at different points were variable from the same patients during the course of diagnosis and treatment of these patients. Our results indicate that in addition to the emphasis on RT-PCR testing, clinical indicators such as computed tomography images should also be used not only for diagnosis and treatment but also for isolation, recovery/discharge, and transferring for hospitalized patients clinically diagnosed with COVID-19 during the current epidemic. These results suggested the urgent needs for the standard of procedures of sampling from different anatomic sites, sample transportation, optimization of RT-PCR, serology diagnosis/screening for SARS-CoV-2 infection, and distinct diagnosis from other respiratory diseases such as fluenza infections as well.

目的:探讨以护士为主导的多学科团队协作(MDT)模式在静脉化疗安全管理中的应用方法及效果.方法:选取2015年10月 ～2017年3月164例静脉化疗患者作为对照组,采用常规管理模式;选取2017年4月 ～2018年10月164例静脉化疗患者作为研究组,实施以护士为主导的MDT模式.比较两组临床效果.结果:两组并发症发生率、化疗健康教育知晓率及满意度比较差异均有统计学意义(P<0.05).结论:以护士为主导的MDT模式应用于静脉化疗安全管理中效果较好,有利于改善化疗效果,提高患者满意度.

目的 调查核医学检查过程中突发病情变化的原因与预防性干预措施.方法 回顾性分析我院2017年9月至2018年9月CT检查室接受检查的11267例患者资料,分析突发病情变化患者的原因.结果 本次接受检查患者中23例突发病情变化,其中增强CT检查后有2例突发猝死、12例突发严重低血糖、3例24 h后发生急性肾功能衰竭,2例突发休克,4例注射对比剂后突发药物过敏.结论 CT检查过程中由于突发病情变化而引发危及生命安全的事件,因此,护理人员应采取相应的处理措施,避免严重突发事件的发生.

Objective To investigate the effects of thyroid hormone on extremely severe traumatic brain injury (TBI).Methods A retrospective case-control study was conducted to analyze the treatment of 105 patients with extremely severe TBI admitted from July 2010 to April 2014.There were 79 males and 26 females,with an average age of 32.9 years.The patients were divided into conventional treatment group (Group A,35 cases),conventional treatment ± thyroxine treatment group (Group B,35 cases) and thyroxine treatment group after the condition that thyroxine level was low (Group C,35 cases) according to the random number table method.The incidence of low T3 and T4,incidence of hypotension,the dosage of vasoactive drugs,function evaluation of liver and kidney damage,Glasgow outcome scale (GOS),and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) within 20 days after admission,and mortality rate within 30 days after admission were compared and analyzed.Results Within 20 days after admission,the rates of low thyroxine levels and hypotension of the Group B (22.9％,77.1％) were significantly lower than those in the other two groups (Group A:40％,100％;Group C:37％,100％) (all P ＜ 0.05).The doses of dopamine and norepinephrine in Group B was significantly lower than the other two groups and the combination rate of vasopressors in Group B was significantly lower than the other two groups (P ＜ 0.05),while there was no significant difference between Group A and Group C (P ＞ 0.05).The corresponding data in Group A and Group C had no statistically significant difference (P ＞ 0.05).The liver and renal dysfunction rates of Group B (29％,31％) were significantly lower than those of the other two groups (Group A:49％,51％;Group C:43％,51％) (all P ＜ 0.05).The corresponding data in Group A and Group C had no statistically significant difference (P ＞ 0.05).GOS in Group B [(4.8 ± 1.9) points] was significantly higher than that in Group A [(3.3 ± 0.2) points] (all P ＜ 0.05) within 30 days after admission and significantly higher than that of itself at the beginning [(3.6 ± 1.1) points] (P ＜ 0.05).The APACHE Ⅱ in Group A was significantly higher than those in other two groups as well as that in Group A at admission (P ＜ 0.05).Mortality rates in Group B (31％) and Group C (29％) were significantly lower than that in Group A (69％) within 30 days after admission (P ＜ 0.05).Conclusions Thyroxine can reduce the incidence of hypotension,liver and kidney injury rate in extremely severe TBI.Prevention is better than the supplementary treatment after severe TBI.Thyroxine can also reduce the mortality of extremely severe TBI within 30 days after admission.

目的 回顾分析脑死亡患者不同时机的甲状腺素治疗,并探讨甲状腺素对血压和器官功能的影响.方法 对收治和转入的137例脑死亡患者按甲状腺素治疗时机分为3组:对照组43例,只给予常规治疗;预防组52例,除常规治疗外,入组时即给予甲状腺素片50 μg/d;补充组42例,除常规治疗外,在测定发现甲状腺素水平低下后补充甲状腺素片50 μg/d.对比分析各组低T3、T4发生率、低血压发生率、血管活性药用量和肝肾功能等.结果 入组后20 d内,预防组低甲状腺素水平和低血压发生率低于其他两组,补充组低于对照组,差异有统计学意义(P<0.05);平均多巴胺和去甲肾上腺素用量补充组低于对照组,预防组低于其他两组,差异有统计学意义(P<0.05);联合用药率和肝肾功能异常率预防组低于其他两组,补充组肝肾功能损伤发生率低于对照组,预防组低于其他两组,差异有统计学意义(P<0.05).结论 甲状腺素片可以降低脑死亡患者的低甲状腺素水平和低血压发生率,减少血管活性药用量,并进一步降低肝肾功能损伤率,且预防效果优于补充治疗.

Intestinal ischemia-reperfusion (I/R) injury is a devastating complication when the blood supply is reflowed in ischemic organs. Gastrin has critical function in regulating acid secretion, proliferation, and differentiation in the gastric mucosa. We aimed to determine whether gastrin has an effect on intestinal I/R damage. Intestinal I/R injury was induced by 60-min occlusion of the superior mesenteric artery followed by 60-min reperfusion, and the rats were induced to be hypergastrinemic by pretreated with omeprazole or directly injected with gastrin. Some hypergastrinemic rats were injected with cholecystokinin-2 (CCK-2) receptor antagonist prior to I/R operation. After the animal surgery, the intestine was collected for histological analysis. Isolated intestinal epithelial cells or crypts were harvested for RNA and protein analysis. CCK-2 receptor expression, intestinal mucosal damage, cell apoptosis, and apoptotic protein caspase-3 activity were measured. We found that high gastrin in serum significantly reduced intestinal hemorrhage, alleviated extensive epithelial disruption, decreased disintegration of lamina propria, downregulated myeloperoxidase activity, tumor necrosis factor-α, and caspase-3 activity, and lead to low mortality in response to I/R injury. On the contrary, CCK-2 receptor antagonist L365260 could markedly impair intestinal protection by gastrin on intestinal I/R. Severe edema of mucosal villi with severe intestinal crypt injury and numerous intestinal villi disintegrated were observed again in the hypergastrinemic rats with L365260. The survival in the hypergastrinemic rats after intestinal I/R injury was shortened by L365260. Finally, gastrin could remarkably upregulated intestinal CCK-2 receptor expression. Our data suggest that gastrin by omeprazole remarkably attenuated I/R induced intestinal injury by enhancing CCK-2 receptor expression and gastrin could be a potential mitigator for intestinal I/R damage in the clinical setting.

目的 探讨提高器官捐献成功率的途径.方法 回顾分析有器官捐献意愿的105例患者的捐献失败及器官维护不力原因.结果 (1)61例因严重器官功能不全或衰竭不能捐献,其中因维护不力在器官获取组织(OPO)到达前心跳停止38例,因肝肾功能衰竭未能捐献23例;(2)未达脑死亡标准24例,其中植物状态19例,高位截瘫并缺氧性脑病未达脑死亡标准2例,肌无力致严重呼吸衰竭3例;(3)其他原因20例,其中家中老人反对12例,要求有偿4例,家属要求捐献后与受者见面2例,百草枯中毒1例,中介介入1例.(4)61例严重器官功能不全或衰竭者中,严重低血容量58例,严重内环境紊乱35例,应用大剂量升压药61例,无一例应用T4.结论 相关人员对脑死亡的判定和脑死亡后器官功能维护等知识的不足是最终捐献失败的主要原因.

[目的]探讨诱导型多能干细胞(iPS-MSC)对脓毒症小鼠肠黏膜通透性的改善作用和对肠道菌群移位的影响.[方法]采用尾静脉注射脂多糖(LPS,10 mg/Kg)建立小鼠脓毒症模型.常规培养及传代iPS-MSC.在脓毒症建立2h和6h经小鼠尾静脉注射进行治疗干预(1×106/只).利用基因重组技术制备新质粒pET28b(+)-EGFP,转染大肠杆菌,并在脓毒症后连续2d予小鼠进行灌胃处理.在脓毒症发生72 h后,取各组小鼠腹水及肠系膜淋巴结匀浆于Kan抗性的LB培养基培养鉴定,计算和比较菌群负荷.通过透射电镜观察小鼠小肠黏膜上皮细胞超微结构的变化.Western blotting法检测各组小鼠肠黏膜ZO-1蛋白的表达.荧光显微镜下观察带有GFP绿色荧光蛋白的ips-MSC在损伤肠黏膜的移行和归巢情况.[结果]成功构建表达绿色荧光的重组大肠杆菌pET-28b(+)-EGFP作为实验用示踪菌.灌胃处理后,ips-MSC治疗的小鼠腹水和肠系膜淋巴结的示踪菌的菌负荷较脓毒症组明显降低,其中ips-MSC 2 h治疗组较6h治疗组降低的更明显.透射电镜观察发现脓毒症小鼠肠系膜上皮细胞间紧密连接结构破坏,细胞间缝隙增宽,而经iPS-MSC治疗的小鼠细胞间紧密连接结构破坏明显改善,在2h治疗组表现更为明显,伴随紧密连接蛋白ZO-1的表达水平升高.[结论]静脉注射iPS-MSC能够向脓毒症小鼠损伤的肠黏膜移行,通过提高连接蛋白ZO-1的表达,修复紧密连接,改善脓毒症小鼠肠黏膜的通透性,减少脓毒症时肠道菌群的移位.

Objective To investigate the effect of anisodamine on oxygen metabolism and organ function in dogs with sepsis.Methods Twenty beagles were divided into sepsis group (n =8) and anisodamine-treated group (n =12) according to the random number table.The sepsis model was established by cecal ligation and puncture.Changes in thrombomodulin (TM),arterial oxygen partial pressure (PaO2),oxgen uptake rate (ERO2) and lactate were mearsured before and 1,3,8 and 24 h after operation.Wet/dry ratio of lung tissues and incidence of multiorgan dysfunction syndrome (MODS) were detected 24 h after operation.Results Level of TM was increased progressively after operation,which was significantly higher in sepsis group than in anisodamine-treated group at 3,8 and 24 h [(28.7±15.9) vs (19.5 ±10.6)ng/ml,(36.5±20.8) vs (21.9±12.8)ng/ml,(52.6±32.7)vs (31.3 ± 18.4)ng/ml respectively] (P ＜ 0.05).The PaO2 decreased slowly after operation,with the decrease more significant in sepsis group than in anisodamine-treated group at 24 h [(65.6 ± 14.5) vs (83.3 ± 16.3)mmHg] (P ＜0.05).The ERO2 had a rise-and-fall trend after operation,with the level lower in sepsis group than in anisodamine-treated group at 24 h [(16.7 ± 3.1) ％ vs (21.7 ± 2.9) ％] (P ＜ 0.05).Level of blood lactate increased gradually,with the level higher in sepsis group than in anisodamine-treated group at 24 h [(4.4 ± 1.2) vs (3.1 ± 0.8) mmol/L] (P ＜ 0.05).Wet/dry ratio of lung tissues in sepsis group was (510 ± 80) ％ versus (370 ± 50) ％ in anisodamine-treated group at 24 h (P ＜ 0.05).Incidence of MODS in sepsis group was 38％ versus 17％ in anisodamine-treated group at 24 h (P ＜ 0.05).Conclusion Anisodamine may ameliorate the injury to vascular endothelial cells and oxygen metabolism disorder after sepsis and hence contributes to the reduction of sepsis-induced MODS.

目的：探讨血清降钙素原及相关感染指标对于外科重症患者出现感染时早期诊断及预后的临床意义。方法危重病患者共77例,分为对照组、脓毒症组、脓毒性休克组,测定其血清降钙素原及相关感染指标,并进行相关统计学分析。结果对照组、脓毒症组、脓毒性休克组的PCT水平依次升高,各组间的差异具有统计学意义(P<0.01)。各组间的白细胞水平、中性粒细胞百分比、体温的差异无统计学意义(P>0.05)。根据受试者工作特征曲线(ROC曲线)的分析结果, PCT、WBC、中性粒细胞百分比、体温的ROC曲线下面积(AUC)分别是0.949、0.657、0.640、0.656, PCT以0.52μg/L为截点诊断外科重症患者脓毒症的性能最高,敏感度为96.1%,特异度为92.3%, Youden指数为0.884。结论 PCT对于诊断外科重症患者发生感染时诊断有良好的应用价值,是早期诊断脓毒症特异性较高的感染指标,并且能反应感染的严重程度。

Global donor shortage has become a key factors affecting the organ transplantion.Here ww briefly review the donor classification and status quo at home and abroad,especially the donation after brain death(DBD) and donation after cardiac death(DCD) and their problems,solutions,brain death pathophysiological changes,problems and solutions in maintenance of brain death.We hope that in this article,there would be some new insight of human organ donation and progression of the development of transplantation in our nation.

OBJECTIVE:To explore the risk factors of fungal infection so as to provide rationales for the prevention of fungal infection after liver transplantation.METHODS:The clinical data of 94 cases of fungal infections after liver transplantation from January 1, 2003 to November 30, 2010 at our hospital were collected as the infective group. A total of 603 liver transplant patients without fungal infections during the same period were selected as the control group. χ(2) test and t test were utilized for the analysis of possible risk factors for fungal infection.RESULTS:Fungal infection rate was 13.5% (94/697) after liver transplantation and mortality rate of fungal infection 86.2% (81/94). Candida albicans was the majority infective fungi. And the main site of infection was the lungs. The postoperative acute physiology and chronic health evaluation III (APACHE III) score of the infective group was significantly higher than that of the control group (26.0 ± 5.4 vs 21.5 ± 4.7, P < 0.01). The number of patients with primary liver cancer was lower than that of the control group (26.6% vs 45.8%, P < 0.01). The number of decompensated HBV cirrhosis and diabetics in the infective group was higher than that of the control group at pre-operation (23.4% vs 11.6%, 9.6% vs 2.8%, both P < 0.01). The number of patients with postoperative mechanical ventilation over 10 days, postoperative antibiotics over 14 days, postoperative cardiopulmonary dysfunction and liver function recovery time over 7 days, parenteral nutrition over 12 days and hyperglycemia over 7 days in the infective group were significantly higher than that in the control group (all P < 0.01).CONCLUSION:Preoperative primary disease, postoperative disease severity, postoperative organ dysfunction, long-term mechanical ventilation, antibiotics and hyperglycemia, etc. may be the important risk factors of fungal infection after liver transplantation.

BACKGROUNDFungal infections after liver transplantation have received considerable interests because of their association with substantial morbidity and mortality. This study investigated risk factors of fungal infection after liver transplantation.MATERIAL/METHODSRetrospective analysis was performed based on clinical data from 120 patients with fungal infection after liver transplantation from January 1, 2003 to May 30, 2012. χ2 test was used to analyze risk factors for fungal infections.RESULTSThe fungal infection rate after liver transplantation is 13.5% (120/886) and the case fatality rate reaches 70.8%; most are infected by Candida albicans (67.5%), with infection located in the lung (73.3%). Acute physiology and chronic health evaluation scores of the infected group are higher than those of the control group 24 hours after the surgery (27.1±5.2 vs. 21.9±5.0). The percentage of primary liver cancer patients in the infected group was lower than in the control group (26.7% vs. 45.8%). Compared to the control group, the infected group had a higher percentage of patients with HBV, gestational diabetes mellitus, and multiple organ dysfunction syndrome. Percentages of patients with long continuous parenteral nutrition time, poorly controlled high blood sugar, long-term mechanical ventilation, and antibiotics use were higher in the infected group than in the control group.CONCLUSIONSPreoperative original attack, postoperative critical condition, chronically high blood sugar, long-term use of antibiotics, and mechanical ventilation are probably vital risk factors for fungal infection after liver transplantation.

目的:分析广东省三级医院ICU现状,为提高广东省ICU总体水平提供依据。方法:采用表格问卷调查形式收集分析广东省47间三级医院ICU(院内最大或最主要的一个ICU)的资料。结果:①ICU规模及性质,ICU平均床位数为(15±8)张,ICU床位数占医院总床位数的2%;74%为综合ICU,26%为专科ICU;床位平均使用率为87%。②设备配置,床旁多功能持续心电监护仪平均数与ICU平均床位数比值为1.08∶1,呼吸机平均数与ICU平均床位数比值为0.83∶1,微量泵平均数与ICU平均床位数比值为1.98∶1,输液泵平均数与ICU平均床位数比值为1.01∶1。配备中央监护站、血液净化仪、纤维支气管镜、主动脉内球囊反搏仪、及床边X光机的比例分别为45/47、44/47、42/47、14/47、1/47。③人员配置,ICU医生平均人数与ICU床位数比值为0.85∶1;ICU护士平均人数与ICU床位数比值为2.8∶1。④技术开展情况,所有ICU均能独立开展机械通气技术和深静脉置管术;96%的ICU开展了纤维支气管镜检查,11%开展了持续血液净化,91%开展了有创血压监测,47%开展了漂浮导管技术。⑤实行急性生理学和慢性健康状况评分(APACHE)的ICU占9%(4/47)。结论:广东省ICU规模及性质、设备、人员配置和技术开展情况基本符合中国重症加强治疗病房建设与管理指南要求。但综合ICU比例有待进一步提高,床位数需进一步增加,ICU的一些重要技术尚有待普及,APACHE评分的应用有待推广。

Objective: To investigate the efficacy of immunotherapy on septic patients with Ulinastatin plus Thymosin-alpha(1).Methods: Seventy postoperative septic patients were divided into two groups at random: the immunotherapy group (n=36) and the conventional therapy group (n=34). Patients in the immunotherapy group received intravenous Ulinastatin of 200 000 U, 3 times per day for 3 days, Ulinastatin of 100 000 U, 3 times per day for 4 days, and subcutaneous injection of Thymosin-alpha(1) of 1.6 mg, twice per day for 3 days, then once per day for 4 days. While conventional therapies such as antibiotics and fluid resuscitation were undertaken in both groups. The expression levels of serum tumor necrosis factor-alpha(TNF-alpha), interleukin-10 (IL-10), IgG, C3, T lymphocyte subsets, CD14 (+) monocyte human leukocyte antigen (locus) DR (HLA-DR) and patients' 28-day survival rate of the two groups were observed and evaluated.Results: The survival rate was significantly higher in the immunotherapy group (63.9%; 23/36) compared with the conventional therapy group (41.2%; 14/34). The serum TNF-alpha levels [(1.38 +/- 0.50) ng/ml in the immunotherapy group vs (1.88 +/- 0.53) ng/ml in the conventional group, P<0.05] and the serum IL-10 levels [(217.52 +/- 15.71) ng/ml vs (101.53 +/- 16.57) ng/ml, P<0.05] were significantly different between the two groups. The serum IgG levels in the immunotherapy group [(17.65 +/- 6.81) g/L] were significantly higher than in the conventional group [(11.94 +/- 5.32) g/L]. There were also significant differences in the expression levels of CD4+ T lymphocyte (35%+/- 13% in the immunotherapy group vs 21%+/- 7% in the conventional group, P<0.05) and CD14+ monocyte HLA-DR (50%+/- 5% in the former vs 35%+/- 4% in the latter, P<0.05).Conclusions: Immunotherapy with Ulinastatin plus Thymosin-alpha(1) can enhance the inflammatory response, improve the immune homeostasis, and increase the survival rate of septic patients.

AIM: To investigate the effect of ulinastatin plus thymosin - a, therapy on improving immune function in septic patients. METHODS: 70 patients were divided into two groups. One group was classical treatment group ( CT) with regular therapy and another group was classical treatment plus immunotherapy group ( CIT) with ulinastatin plus thymosin -a, for a week. The immune index before and after treatment on day 0,1,3 and 7 was observed, including the clinical and survival data. RESULTS: The most common pathogen of sepsis was bacteria, and infection by fungi was in rare. The common locations of bacteria observed were sputum and abdominal drainage. The level of TNF - α was significant lower in CIT group than that in CT group (P <0.05). IL - 10 level was significantly higher in CIT group than that in CT group (P < 0.05 ). IgG level was significant lower in CIT group than that in CT group (P < 0.05 ). No significant difference in the levels of IgA, IgM, C_3 and C_4 between two groups was observed (P > 0.05 ). CD4~+ T lymphocytes were significant higher in CIT group than those in CT group (P < 0.05 ). From day 7 to day 28, the lymphocytes and level of HLA -DR in CD14~+ monocytes were significant higher in CIT group than those in CT group (P < 0.05). The time of mechanical ventilation and vasopressors used in CIT group was shorter than those in CT group ( P < 0.05 ). But the length of stay and the cost in ICU showed no significant increase between these two groups (P >0.05). During hospitalization, 20 patients died in the CT group and 13 patients died in CIT group ( P < 0.05 ). The long - term survival time in CIT group was longer than that in CT group ( P < 0.05 ). CONCLUSION: Immunotherapy in septic patients can decrease TNF - α level and increase IL - 10 level. Immunotherapy in septic patients can increase IgC level slightly, CD4~+ T lymphocyte, and HLA - DR in CD14~+ monocytes, which improve the immune paralysis in septic patients. Immunotherapy can shorten the time of mechanical ventilation and vasopressors used, but it doesn't increase the length of stay and the cost.

Objective To knowledge the mechanism of immunomodulation, westudy immunomodulation effect on neutrophil leukocyte and lymphocyte subsets in septic rat.Methods Cecal ligation-perforation(CLP)rat model were divided intothree groups includingshamgroup(n =20), control group(n =20)and experimental group(n=20).Blood collections were made after CLP model in 3, 12, 24, 48 h respectively.Leukocyte, neutrophil leukocyte, lymphocyte counting and CD4+, CD8+ T lymphocyte were detected.Results CLP rat as septic model, leukocyte and neutrophil leukocyte in experimental group decreased more significant than that in control group, P<0.05.Lymphocyte in experimental group increased more significant than that in control group, P<0.05.CD4+ T lymphocyte in experimental group increased more significant than that in control group, P<0.05.CD8+ T lym-phocyte had no difference in two groups.Conclusions Immunomodulation in septic rat can decrease leukocyte and neutrophil leukocyte and alleviate sequential inflammatory reaction.Immunomodulation in septic rat can increase lymphocyte and CD4+T lymphocyteand improve immunefunction as a matter of fact.