血液滤过亚低温对重症脑损伤炎症介质的影响

Effects of hemofiltration mild hypothermia on inflammatory mediators in patients with severe traumatic brain injury

目的通过对血液滤过亚低温与传统亚低温疗法效果的比较,探讨其对重症脑损伤患者血中肿瘤坏死因子(TNF)-α、白介素(IL)-18及细胞间黏附分子(ICAM)-1水平及患者预后的影响。方法选择重型脑损伤患者32例,随机分为2组,血液滤过组16例,传统降温组16例。伤后6h血液滤过组开始采用血液滤过体外循环降温,传统降温组入院后立即采用头部冰帽及背部冰毯物理降温,2组病例均每小时监测1次直肠温度变化,并于治疗前和治疗后9h采集动脉血检测炎症介质的浓度。进行治疗后2组恢复良好率的比较。结果血液滤过组治疗后9h较治疗前3种炎症介质均明显降低,分别为TNF-α〔(23.85±1.62)vs(52.35±0.72)μmol/L,P<0.05〕,IL-18〔(7.36±3.29)vs(15.20±3.66)μmol/L,P<0.05〕和ICAM-1〔(6.56±2.38)vs(12.58±3.68)μmol/L,P<0.05〕;且明显低于传统降温组,分别为TNF-α〔(23.85±1.62)vs(53.85±1.32)μmol/L,P<0.05〕,IL-18〔(7.36±3.29)vs(12.35±4.12)μmol/L,P<0.05〕和ICAM-1〔(6.56±2.38)vs(12.37±2.61)μmol/L,P<0.05〕。血液滤过组恢复良好率明显高于传统降温组(56.25%vs25.00%,P<0.05)。结论血液滤过亚低温方法用于脑损伤后的治疗,能清除血中的炎症介质TNF-α、IL-18、ICAM-1,提高患者的恢复良好率,改善患者的预后。

Objective To investigate the impact of hemofihration mild hypothermia on the blood level of tumor necro- sis factor（TNF）-α,interleukin（IL）-18,intercellular adhesion molecular（ICAM）-1 and on the prognosis in the patients with severe traumatic brain injury. Methods Eligible 32 patients with severe traumatic brain injury were randomly divided into two groups ：hemofiltration mild hypothermia group and traditional mild hypothermia group （n = 16 each）. The patients were cooled by hemofihration during extracorporeal circulation 6 hours after injury in hemofiltration mild hypothermia group, and the pa- tients were physically cooled by the head ice caps and back ice blanket immediately when they were admitted to hospital in tra- ditional mild hypothermia group. The rectal temperatures were monitored once a hour after treatment, and the arterial blood concentration of inflammatory mediators （TNF-α, IL-18 and ICAM-1 ） were detected by ELISA method before treatment and 9 hours after treatment respectively in all the patients of two groups. The good recovery rates of two groups were compared. Resuits Compared with pretreatment,TNF-α[（23.85 ±1.62） vs（ 52.35 ±0.72） μmol/L],IL-18[ （7.36±3.29） vs （15.20 ±3.66） μmol/L] and ICAM-1[ （6.56 ＋2.38） vs （12.58 ±3.68） μmol/L3 significantly decreased （all P〈0.05） in hemofihration mild hypothermia group, and compared with traditional mild hypothermia group , TNF-α [ （23.85 ± 1.62 ） vs （53.85 ±1.32） μmol/L],IL-18（7.36±3.29） vs （12.35 ±4. 12 ） μmol/L]and ICAM-1[（6.56±2.38） vs （12.37±2. 61 ） μmol/L] 9 hours after treatment significantly decreased as well （ all P 〈 0. 05 ） in hemofihration mild hypothermia group. The mentioned above inflammatory mediators had no obvious difference before and after treatment in traditional mild hy- pothermia group. The good recovery rate of hemofiltration mild hypothermia group was significantly higher than that in traditional mild hypothermia group （56. 25 % vs 25.00%, P 〈 0. 05 ）. Conclusions Hemofihration mild hypothermia for the therapy of severe traumatic brain injury could eliminate the inflammatory mediators including TNF-α, IL-18 and ICAM-1, raise the good recovery rate and imorove orognosis of oatients.