连续性血液净化治疗多器官功能障碍综合征的临床研究

Clinical research of continuous blood purification for multiple organ dysfunction syndrome

目的研究连续性血液净化(CBP)的各种治疗方式对多器官功能障碍综合征(MODS)患者炎症因子的清除作用及对预后的影响。方法对ICU中112例MODS患者根据病因分为3组,分别进行血液灌流联合血液透析/滤过治疗(HP+CVVH/CVVHD)、高容量血液滤过(HVHF)、血液滤过/透析治疗(CVVH/CV-VHD),观察生命体征变化,检测生化指标,并分别于治疗开始时(0h)和治疗后3h、24h取血检测肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)。结果所有MODS患者经连续性血液净化治疗后,生命体征趋于平稳,血气分析、血电解质、肝肾功均有明显改善。CVVH/CVVHD组的TNF-α、IL-6、CRP等炎症因子在治疗前后的变化差异无统计学意义;HP+CVVH/CVVHD组TNF-α、IL-6、CRP在治疗3h后的变化差异有统计学意义,但随着治疗的进行其数值又开始逐渐升高,其治疗24h后的数值与治疗前相比差异无统计学意义;HVHF组随着治疗的进行TNF-α、IL-6、CRP的数值均呈进行性下降,与治疗前相比差异有统计学意义。结论 1)在清除炎症因子方面,高容量血液滤过模式明显优于血液滤过(透析)和血液灌流联合血液滤过(透析)。2)血液灌流联合血液滤过(透析)治疗后,在短时间内可以使各炎症因子的平均水平下降,但由于灌流器的吸附量在一段时间后达饱和状态,炎症因子的清除作用下降甚至消失。

Objective To research the clear role of inflammatory factors and the affect of prognosis about the various treatment of Continuous Blood Purification（CBP） for the patients who got Multiple Organ Dysfunction Syndrome（MODS） in intensive care unit（ICU）. Methods 112 patients who got MODS were separated into the CVVH/ CVVHD,HP＋CVVH/CVVHD and HVHF separately treatment according to the cause of disease. The chang vital sign and the biochemical indicators was observed. And the TNF-a ,IL-6 and CRP from the blood were measured before treatment and after 3 hours and 24 hours of the treatment.Results After the treatment of CBP,vital signs of all the patients tended to be equability and the blood gas analysis, blood electrolyte and liver and kidney function were improved obviously. There were no statistical differences in the changes of the inflammation factors such as TNF-a, IL-6 and CRP in the CVVH/CVVHD group before and after treatment. However, TNF-a, IL-6 and CRP in HP＋CVVH/CVVHD group showed significant changes at the 3 hours after treatment,and their numerical value began to gradually raise as the treatment continued. There were no statistical differences in these numerical values of 24 hours after the treatment compared with that of fore treatment. The numerical value of TNF-a , IL-6 and CRP in HVHF group showed a progressive decrease which had statistical differences compared with that of fore treatment. Conclusion In the clearing inflammatory factors, the model of HVHF is better than the models of CVVH/CVVHD and HP＋CVVH/CVVHD. Mter the treatment of HP ＋ CVVH/CVVHD, the average levels of each inflammatory factor could decrease in a short time, but the effect of clearing inflammatory factor will be down-regulated and even disappear as a result of the adsorption quantity of the perfusion which attains to be equilibrium.