连续性血液净化对严重创伤后应激反应的影响

Effect of continuous renal replacement treatment on stress reaction in patients with severe trauma

目的 探讨连续性血液净化 (CBP)对严重创伤后患者应激反应的影响及其临床意义。方法 将2 9例严重创伤患者中 15例在伤后 12 h内进行连续性静静脉血液滤过 (CVVH)治疗者定为 CBP治疗组 ,其余 14例为对照组。定时检测两组患者血浆中皮质醇、白细胞介素 6 (IL 6 )和肿瘤坏死因子 α(TNFα)的水平 ,并观察患者体温、心率、呼吸、血压等变化。结果 伤后 12 h两组皮质醇、IL 6水平均明显升高。对照组皮质醇呈进行性升高 ,4 8h前后达到高峰 ,72 h后仍明显高于正常 ,且 IL 6亦进行性升高。治疗组皮质醇在2 4 h后逐渐降低 ,72 h其血浆水平接近正常 ,在 2 4、4 8和 72 h时的血浆水平均显著低于对照组 (P均 <0 .0 0 1) ;IL 6于 12 h后随即显著降低 ,在 2 4、4 8和 72 h时的血浆水平均明显低于对照组 (P均 <0 .0 5 )。伤后两组 TNFα呈持续升高趋势 ,但两组间无统计学差异。CBP治疗组患者的临床症状也显著改善。结论 CBP能有效清除患者血中的应激激素 ,降低应激反应 ;其中 IL 6的变化较皮质醇更为灵敏。

Objective To investigate the effect of continuous renal replacement treatment(CRRT) stress reaction in patients with s evere trauma and its clinical significance. Methods Twenty-nine patients with severe trauma were randomly divided into two groups: trea tment group 〔15 cases, treated with continuous veno-venous hemof iltration(CVVH) within 12 hours after trauma〕 and control group (14 cases, not treated with CVVH). The levels of cortisol, interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in plasma were determined at 12 hours, 24 hours, 48 hours, 72 hours after trauma, and the temperature, heart beat, respiratory rate, blood pressure were observed. Results The levels of cortisol, IL-6 in both groups increased to some de gree in 12 hours. In control group, the level of cortisol increased gradually, p eaking at 48 hours, and it was still higher than normal at 72 hours. The level o f cortisol decreased in the treatment group gradually after 24 hours, approa ching normal level at 72 hours. When compared with the control group, the le vels of cortisol in plasma were lower obviously in the treatment group at 24 ho urs, 48 hours, 72 hours(all P<0.001). The level of IL-6 decreas ed obviously after 12 hours and was lower evidently at 24 hours,48 hours, 72 hou rs(all P<0.05). The clinic symptoms were improved obviously. The level of TNF-α was increased at each time point in both groups, but there was no significant difference between two groups. Conclusion CRRT can eliminate effectively the stress hormone, and reduce stress reaction obviously. The change in IL-6 is more mark ed than that of contisol.