高容量血液滤过在多器官功能障碍综合征患者中临床应用评价

The clinical application of high-volume hemofiltration in the patients with multiple organ dysfunction syndrome

目的:观察高容量血液滤过(HVHF)对多器官功能障碍综合征(MODS)患者炎症介质的清除作用,探讨HVHF对MODS患者的治疗效果。方法:19例MODS患者随机分为两组,HVHF治疗组10例,连续性静脉-静脉血液滤过(CVVH)治疗组9例;用酶联免疫吸附法(ELISA)测定HVHF和CVVH治疗前和治疗后患者血清中肿瘤坏死因子-α(TNFα)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平,并观察两组患者的死亡率和血浆尿素氮(BUN)、肌酐(Scr)值的变化。结果:HVHF和CVVH治疗后,患者血浆中BUN、Scr均降低(P<0.05),两组患者治疗后与治疗前相比血清TNFα、IL-6、IL-8水平均有下降(P<0.05);与CVVH治疗组相比,HVHF治疗组患者血清中TNFα、IL-6、IL-8下降更为明显(P<0.05)。结论:HVHF治疗能明显增加MODS患者血清中TNFα、IL-6、IL-8的清除能力,改善MODS患者的预后。

Objective：To observe the effects of high-volume hemofiltration（HVHF）on the cytokines in the patients with multiple organ dysfunction syndrome and to investigate the therapitic action of HVHF for the patients with MODS.Methods：19 patients with multiple organ dysfunction syndrome were randomly divided into HVHF group（n=10）and CVVH group（n=9）,the levels of serum tumor necrosis factor-α（TNF-α）,interleckin-6（IL-6）and interleckin-8（IL-8）were measured by enzyme-linker immunoadsorbent assay（ELISA）before and after the therapy,and to observe the death rates and the levels of BUN and Scr.Results：Compared with that before the therapy,the average concentrations of plasma creatinine and urea were decreased significantly after HVHF or CVVH（P0.05）.The level of TNF α,IL-6,IL-8 in two groups all decreased after HVHF or CVVH（P0.05）;Compared with CVVH group,the level of TNF α,IL-6,IL-8 after the HVHF curing were lower（P0.05）.Conclusions：HVHF could decrease the levels of inflammatory mediator in the patients with MODS,and improve the survival rate of MODS patients.