M-100型血液滤过器对多器官功能障碍综合症中炎症介质的清除作用

M-100 continuous hemodialysis filtration medium for removing inflammatory mediators in patients with multiple organ dysfunction syndrome

目的:探讨使用M-100型血液滤过器的连续性静脉-静脉血液透析滤过(CVVHDF)对多器官功能障碍综合征(MODS)患者血清炎症介质的清除作用及是否能改善患者的临床症状及预后。方法:选取新疆医科大学第五附属医院2013年9月到2015年12月符合MODS或全身炎症反应综合征或脓毒症诊断标准的患者40例,分成治疗组22例和对照组18例。对照组患者行常规内科治疗,治疗组患者行常规内科治疗联合CVVHDF连续治疗3 d以上。分析治疗的前3 d两组患者血清中炎症介质浓度变化,用酶联免疫吸附试验方法测定血清肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-10水平;密切观察并记录患者生命体征、BUN及Cr;同时观察患者总住院天数及生存率。结果:治疗组存活16例,生存率为72.73%;对照组存活7例,生存率为38.89%,治疗组生存率高于对照组(P<0.05)。治疗组总住院时间为(14.60±4.12)d,对照组总住院时间为(18.20±4.51)d,治疗组总住院时间较对照组短(P<0.05)。治疗组治疗后TNF-α、IL-6、IL-10血清浓度较对照组明显降低,差异有统计学意义(P<0.05)。治疗组治疗后APACHE Ⅱ评分、BUN、Cr浓度、平均动脉压、心律、氧饱和度较对照组治疗后的改善更明显,差异有统计学意义(P<0.05)。结论:CVVHDF有清除MODS患者体内炎症介质的作用,可能有改善患者的临床症状及预后的作用。

Objective To explorethe effect of continuous veno-venous hemodifiltration （CVVHDF） using M-100 continuous hemodialysis filtration medium for clearance of inflammatory mediators in patients with multiple organ dysfunction syndrome （MODS） and for improving the clinical symptoms and prognosis of the patients. Methods Between September, 2014 and December, 2015, 40 patients who met the diagnostic criteria of MODS, systemic inflammatory response syndrome （SIRS） or sepsis were admitted in the Fifth Affiliated Hospital of Xinjiang Medical University. The patients were divided into treatment group （n=22） and control group （n=18） to receive routine medical treatment combined with CVVHDF and routine medical treatment alone for more than 3 days, respectively. In the first 3 days of treatment, the changes in serum concentrations of inflammation mediators were analyzed, and the levels of tumor necrosis factor （TNF）-α, interleukin-6 （IL-6） and IL-10 were determined with ELISA; the vital signs, BUN and Cr levels of the patients were also recorded. The total hospital stay and survival rate of patients were analyzed. Results Sixteen （72.73%） patients in the treatment group survived as compared with only 7 （38.89%） in the control group （P〈0.05）. The total hospital stay was significantly shorter in the treatment group than in the control group [（14.60±4.12） d vs （18.20±4.51） d, P〈0.05]. After the treatment, the patients in the treatment group showed significantly lower TNF-α, IL-6, and IL-10 levels （P〈0.05） and presented with more obvious improvements in APACHE II score, BUN, Cr level, mean arterial pressure, heart rate, and oxygen saturation （P〈0.05） than those in the control group. Conclusion CVVHDF can effectively remove inflammatory mediators in patients with MODS and improve the clinical symptoms and prognosis of the patients.