连续性血液净化治疗全身炎症反应综合征的效果

Clinical outcomes of continuous blood purification in patients with systemic inflammatory response syndrome

目的探讨连续性静脉-静脉血液滤过(CVVH)治疗全身炎症反应综合征(SIRS)的临床效果。方法 60例SIRS患者分别采用CVVH(CVVH组,30例)和常规治疗(对照组,30例)。监测治疗前后两组患者体温、HR、RR和外周血WBC计数,ELISA法检测血清TNF-α、IL-1、IL-6和IL-8的水平,比较两组多器官功能障碍综合征(MODS)的发生率和ICU住院时间。结果治疗后,CVVH组患者血清TNF-α、IL-1、IL-6和IL-8水平的下降均快于对照组(P<0.01),体温、HR、RR和外周血WBC计数改善效果均优于对照组(P<0.01)。与对照组相比,CVVH组MODS发生率低(6.67%vs.33.33%)(P<0.01),ICU住院日少[(8.4±2.9)d vs.(13.2±4.1)d](P<0.01)。结论 CVVH可以清除SIRS患者体内过度释放的炎症因子,有效阻断SIRS向MODS发展的进程。

Objective To study the clinical outcomes of continuous venous-venous hemofiltration（CVVH）in the patients with systemic inflammatory response syndrome（SIRS）.Methods Sixty patients with SIRS were randomly and equally divided into two groups of A（received CVVH treatment）and B（received conventional treatment）.The changes of clinical indicators including temperature,heart rate（HR）,respiratory rate（RR）and white blood cell（WBC）count were monitored and serum levels of inflammatory cytokines including TNF-α,IL-1,IL-6 and IL-8 were determined using ELISA before and after treatment.The incidence rate of multiple organ disorder syndrome（MODS）and ICU stay were compared between two groups.Results The descrease in serum levels of TNF-α,IL-1,IL-6 and IL-8 was faster in group A than that in group B（P〈0.01）,and the improvements of temperature,HR,RR and WBC count were better in group A than those in group B after treatment（P〈0.01）.Compared with group B,the incidence rate of MODS was lower（6.67% vs.33.33%）and ICU stay were less[（8.4±2.9）d vs.（13.2±4.1）d]in group A（P〈0.01）.Conclusion CVVH treatment is able to remove the excessive release of inflammatory cytokines and effectively block the process of SIRS to MODS in the patients with SIRS.