持续低效血液透析滤过对蜂蜇伤后多脏器功能障碍综合征患者预后及炎症因子的影响

Effects of sustained low - efficiency diafiltration on prognosis and inflammatory cytokine in patients with multiple organ dysfunction syndrome following wasp sting

目的观察持续低效血液透析滤过（SLEDF）对蜂蜇伤后多脏器功能障碍综合征（MODS）患者预后及炎症因子的影响，探讨SLEDF对蜂蜇伤后MODS患者的治疗作用。方法29例蜂蜇伤后MODS患者，随机分为持续静脉-静脉血液滤过（CVVH）组（14冽）和SLEDF组（15例）。比较两组死亡率、肾脏痊愈率和进入多尿期的时间；对比两组治疗前、治疗第3天和第7天的急性生理学与慢性健康状况评分（APACHE）Ⅱ、血肌酐（Scr）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1β、IL-10的水平。结果两组患者死亡率、肾脏痊愈率和进人多尿期的时间比较差异无统计学意义（P〉0．05）。在治疗第3天，两组APACHEⅡ、Scr、TNF-α、IL-1β和IL-10水平均较治疗前下降，在治疗第7天进一步下降（P〈0．05或0．01）；而两组APACHEⅡ、Scr、TNF-α、IL-1β和IL-10水平在3个时间点的比较差异均无统计学意义（P〉0．05）。结论对于蜂蜇伤后MODS患者，SLEDF具有和CVVH相似的清除炎症因子和改善预后的作用。

Objective To observe effects of sustained low - efficiency diafiltration （SLEDF） on prognosis and inflammatory cytokine in patients with multiple organ dysfunction syndrome （MODS） following wasp sting and to investigate the therapeutic action of SLEDF for the patients with MODS following wasp sting. Methods Twenty - nine patients with MODS following wasp sting were randomly divided into continuous veno -venous hemofihration （CVVH） group with 14 patients and SLEDF group with 15 patients. Mortality, ratio of renal healing and time of reaching polyuria stage were observed. And score of acute physiology and chronic health evaluation （APACHE） Ⅱ, serum levels of creatinine, tumor necrosis factor - α（ TNF - α ）, interleukin （IL） - 1β and IL - 10 were compared before treatment, on third and seventh day after treatment between two groups. Results There were no significant differences of mortality, ratio of renal healing and time of reaching polyuria stage between two groups （P 〉 0.05, respectively）. Scores of APACHE Ⅱ , serum levels of creatinine, TNF - α, IL - 1βand IL - 10 in CVVH group and SLEDF group were lower on third day after treatment than before treatment, and were significantly decreased on seventh day after treatment （ P 〈 0. 05 or 0. 01, respectively）. And there were no significant differences of scores of APACHE Ⅱ, serum levels of creatinine, TNF-α, IL - 1β and IL - 10 at three time - points between two groups （P 〉 0.05, respectively）. Conclusion Compared with CVVH, SLEDF could clear inflammatory cytokine and improve prognosis in patients with MODS following wasp sting.