超滤量的血液滤过对全身炎症反应的影响

Effects of high volume hemofiltration on systemic inflammatory response

目的研究高流量血液滤过(HVHF)对全身炎症反应综合征(SIRS)患者炎症介质水平和预后的影响。方法对ICU内31例SIRS患者接收血液滤过治疗,随机分为超滤量60ml·kg-1·h-1的HVHF组(15例)和超滤量35ml·kg-1·h-1的连续性静脉静脉血液滤过(CVVH)组(16例),每次血液滤过治疗时间不少于24h。分别于血液滤过前(T0)、滤过12h(T1)及24h(T2)抽取静脉血检测肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-8,并观察SIRS指标和APACHEⅡ评分。结果 T1时,HVHF组TNF-α、IL-6水平显著下降且低于CVVH组(P<0.05);T2时两组TNF-α、IL-6下降均不明显。两组的IL-8在治疗24h中均缓慢下降。两组治疗后SIRS指标和APACHEⅡ评分均显示明显改善,HVHF组的存活率明显高于CVVH组(P<0.05)。结论 HVHF降低SIRS患者炎症介质的效果较CVVH更为明显。

Objective To observe the effects of high volume hemofiltrafion（HVHF）on inflammatory mediators in patients with systemic inflammatory response syndrome（SIRS）.MethodsSIRS patients were devided into two groups of HVHF（60 ml·kg-1·h-1 ,15 cases） and CVVH（continuous veno-venous hemofiltration）（35 ml·kg-1·h-1 ,16 cases）,which was performed for 24 h or more. Plasma levels of tumor necrosis factor-α（TNF-α）,interleukin（IL）-6 and IL-8 were examined before（T0）,at 12 h（T1） and 24 h（T2） during hemofiltration.SIRS criteria and APACHEⅡ scores were recorded.Results Plasma levels of TNF-α and IL-6 at T1 were lower in group HVHF than those at T0 and in group CVVH（P0.05）.The decreases of TNF-α and IL-6 at T2 were not significant in both groups.Plasma level of IL-8 dropped down slowly during 24 h hemofiltration in two groups（P0.05）.The significant improvements in SIRS criteria and APACHEⅡ scores were seen in both groups with a higher survival rate of group HVHF than that of group CVVH（P0.05）.Conclusion The outcomes of HVHF are better than CVVH in attenuating inflammatory responses in SIRS patients.