难治性肺源性心脏病患者连续性血液滤过治疗过程中炎症介质的变化

Variation of inflammatory mediators in continuous veno-venous hemof＇dtration treatment of re- fractory pulmonary heart disease

目的探讨连续性静脉-静脉血液滤过（CVVH）对难治性肺心病患者炎症介质的影响。方法收集难治性肺心病心力衰竭患者106例，分为治疗组（加用CVVH治疗）和对照组（拒绝采用CVVH治疗）。检测所有患者治疗前、治疗后第1、3、7天血浆中肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1B、IL6和IL-8的水平，并进行比较。结果采用CVVH治疗后，患者血浆TNF-α、IL-1β、IL-6、IL-8在CVVH治疗后1、3天逐渐下降，第7天较第3天虽然有所下降，但差异无统计学意义。对照组患者在治疗后第1、3天炎症介质逐渐升高，7天后存活患者血浆炎症介质也出现下降，但仍高于治疗组。结论CVVH可以有效清除难治性肺心病患者血浆中炎症介质，减轻全身炎症反应，降低死亡率。

Objective To study the influence of inflammatory mediators of continuous veno-ve- nous hemofihration（CVVH） on treatment of refractory pulmonary heart disease. Methods 106 patients with refractory pulmonary heart disease were retrospectively analyzed and divided into two groups including routine treatment group （Control group ） and routine treatment combined with CVVH group （Treated group）. Plasma concentration of tumor necrosis factor （TNF） -α, interleukin （IL） -1β, IL-6 and IL-8 were tested before and after treatment of 1,3 and 7 days. Results The levels of TNF-α, IL-1β, IL-6 and IL-8 in treated group decreased gradually after treatment of 1 and 3 days ; They were lower after 7-day treatment than those after 3-day treatment, but the difference was not statistically significant. The levels of TNF-α, IL-1β, IL-6 and IL-8 in control group increased gradually after treatment of 1 and 3 days, and began to fall after 7-day treatment, but still higher than those of the treated group. Conclusion The treatment with CVVH can effectively remove inflammatory mediators ,reduce systemic inflammation and lower mortality in patients with refractory pulmonary heart disease.