日间高流量血液滤过对多器官功能障碍综合征的作用研究

Effects of daytime high-volume hemofiltration in patients with multiple organ dysfunction syndrome

目的观察日间高流量血液滤过对多器官功能障碍综合征（MODS）的影响。方法 28例MODS患者随机分为传统血液滤过组和高流量血液滤过组,分别接受血液滤过每次10-16小时和8-12小时,共3-5天。检测治疗前后TNF-α、IL-6、IL-10、CRP浓度,以及治疗前后血BuN、Cr、K^＋、pH和平均动脉压（MAP）心率（HR）、呼吸（R）、APACHE-Ⅱ评分。结果普通血液滤过组TNF-α、IL-6、IL-10治疗后较治疗前稍有下降（P〉0.05）,高流量血液滤过组治疗后较治疗前明显下降（P〈0.05）,两组治疗前后血BuN、Cr、K^＋、PH以及MAP、HR、R、APACHE-Ⅱ均有改善（P〈0.05）,高流量组医院内生存率高于普通组（P〈0.05）。结论日间高流量血液滤过能有效降低TNF-αI、L-6、IL-10,改善机体器官功能,提高医院内生存率。

Objective To investigate the effects of daytime high-volume hemofiltration on organ function in patients with multiple organ dysfunction syndrome.Methods 28 patients were randomly divided into ordinary hemofiltration group（n=15） and high-volume hemofiltration group（n=13）.The BuN and serum Cr,K^＋,pH,TNF-α,IL-6,IL-10 and CRP were observed before and after treatment.Mean arterial pressure（MAP）,heart rate（HR）,respiration（R） and APACHE-Ⅱ score were monitored.Results Compared with that before the therapy,the average concentrations of serum BuN,Cr,K^＋,pH and APACHE-Ⅱ score after treatment were decreased significantly in the two groups.TNF-α,IL-6,IL-10 and CRP decreased more significantly in high volume hemofiltration group than that in ordinary group.Patient in two groups showed stable blood flow dynamic after treatment.Conclusion Day-time high-volume hemofiltration can effectively remove TNF-α,IL-6,IL-10 and CRP from circulation.