应用聚偏氟乙烯-丝氨酸吸附膜血液灌流治疗猪脓毒血症的实验研究

Effects of direct hemoperfusion with polyvinylidene difluoride - serine column in pigs with experimental sepsis

目的 研究聚偏氟乙烯（polyvinylidene difluoride,PVDF）-丝氨酸吸附膜血液灌流的清除血液中内毒素的能力和对脓毒血症预后的影响.方法 雄性家猪16头,给予内毒素1 μg/（kg·h）静脉泵入2 h复制脓毒血症模型.随机分为：实验组（8头）,应用PVDF-丝氨酸吸附膜进行血液灌流2 h;对照组（8头）,仅复制脓毒血症模型,不进行血液灌流.于基础期和开始内毒素注射后第1、2、3、4、5小时分别测定血浆内毒素浓度、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）和白细胞介素-6（interleukin-6, IL-6）水平;并观察72 h死亡率.结果 实验组内毒素水平显著低于对照组[（0.031±0.016）EU/mL vs. （0.141±0.027）EU/mL,P=0.009];组间TNF-α、IL-6比较,差异有统计学意义（P＜0.05）;肺、肠、肝的组织病理学检查亦显示实验组损伤程度较对照组明显减轻;实验组死亡率25%,对照组87.5%（P=0.003）.结论 应用 PVDF-丝氨酸吸附膜进行血液灌流,可以有效清除内毒素,降低TNF-α和IL-6,减轻炎症反应,降低脓毒血症的死亡率.

Objective To study the effect of removing lipopolysaccharides （LPS） in blood and the influence on prognosis by hemoperfusion（HP） with polyvinylidene difluorideserine（ PVDF -Ser） in pigs with sepsis. Methods Sixteen male family pigs were injected endotoxin （1 μg/（ kg · h） intravenously） for 2 h and randomly assigned to either group （ n = 8 per group ） ： only endotoxin intravenously without HP （ control group ） ; HP with PVDF - Ser column for 2 h after endotoxin （experiment group）. Blood samples were drawn at baseline and 1,2,3,4,5 h after endotoxin injection for the measurement of plasma eytokine concentrations. The mortality rates at 72 h after endotoxin administration were observed and compared. Results The concentration of endotoxin in experiment group was significantly lower than in the control group[ （0. 031 ± O. 016） EU/mL vs （0. 141 ± 0. 027） EU/mL, P = 0. 009 ] and the concentrations of tumor necrosis factor - α （ TNF - α ）, interleukin - 6 （ IL - 6） in experiment group were also lower than in the other group （ P 〈 0. 05 ）. An histopathology examination of the lung, intestine and liver showed tissue damage in the control group was more severe than in the experiment group. The mortality rates at 72 h after endotoxin injection were 25% and 87. 5% for the experiment group and control group, respectivlely. （P = 0. 003 ） . Conclusion Direct hemoperfusion with PVDF - Ser column effectively adsorbed endotoxin in vivo, had an inhibitory effect on plasma cytokines and reduced the inflammatory responses and mortality in endotoxemia.