连续性血液净化治疗对儿童严重脓毒症患儿外周血炎症因子的影响

Effect of continuous blood purification on plasma cytokines in children with severe sepsis

目的探讨连续血液净化(CBP)技术对脓毒症患儿外周血细胞因子的影响。方法21例脓毒症患儿经股静脉留置单针双腔导管,使用Baxter BM25血滤系统行床边CBP治疗。检测CBP治疗前后血浆尿素氮(BUN)、肌酐(Cr)、K+的浓度,并检测动脉血pH值、HCO3-;在治疗前和治疗后1、3、6、24h分别取静脉血,采用ELISA法测定血浆肿瘤坏死因子-α(TNF-α),白介素-1(IL-1)、IL-6、IL-8、IL-10含量。结果所有患儿CBP治疗后血BUN、Cr、K+均明显下降,HCO3-升高(P<0.001),酸中毒得到改善。CBP治疗后血浆中TNF-α、IL-1、IL-8、IL-10水平均较治疗前明显降低(P<0.01),其中TNF-α、IL-1、IL-6在治疗3h后均较治疗前水平明显降低(P<0.01);IL-8治疗后1h时较治疗前明显降低(P<0.05)。结论CBP能改善脓毒症患儿血生化指标,可以用于脓毒症的治疗,同时可清除血浆中部分细胞因子。

Objective To explore the influence of continuous blood purification （CBP） on plasma cytokines in children with severe sepsis.Methods A double lumen catheter was inserted into the femoral vein of 21 children with severe sepsis,and CBP was performed using the Baxter BM25 system.Blood urea nitrogen （BUN）,plasma creatinine （Cr）,K＋ and arterial blood gas were measured before and after CBP,and the plasma levels of tumor necrosis factor-α （TNF-α）,interleukin-1 （IL-1）,IL-6,IL-8,and IL-10 were measured by ELISA at 0,1,3,6,and 24 h after CBP.Results BUN and plasma Cr and K＋ levels decreased and HCO3- increased significantly after CBP （P0.001）,which also resulted in significant reduction of the plasma concentrations of TNF-α,IL-1,IL-8 and IL-10 （P0.01）.The plasma TNF-α,IL-1,and IL-8 levels were significantly lower at 3 h after CBP than those before CBP （P0.01）.Conclusions CBP can improve the blood biochemical markers and clear some plasma cytokines in children with severe sepsis.