多器官功能障碍综合征患者细胞因子释放规律及CVVH干预治疗对其预后的影响

The release pattern of cytokines in patients with multiple organ dysfunction syndrome and the effedts of continous venovenous hemofiltration on prognosis

目的 观察多器官功能障碍综合征 (MODS)患者 3种细胞因子的释放规律及连续性静脉静脉血液滤过 (CVVH)干预治疗对其预后的影响。方法 选择 5 0例符合MODS诊断标准的住院患者 ,随机分为两组 ,治疗组常规治疗加CVVH。两组患者均于入院时、 1 2、 2 4、 4 8、 72、 96和 1 6 8h分别留取血样 ,治疗组于CVVH前后分别留取血样、滤液样数份置零下 4 0℃冰冻待验。结果 治疗组TNF α、IL 1 β分泌高峰在病程初中期 ,对照组在病程后期 ,CVVH ,可使其分泌高峰提前 ,但对 3种细胞因子 (ck)血浆浓度无明显影响。所有滤液中可检出 3种细胞因子 ,治疗组血流动力学及氧合功能改变明显优于对照组 ,病死率及预计死亡率较对照组低。结论 在MODS患者病程早期做CVVH治疗 ,可以减轻或部分阻断细胞因子的过度释放 。

Objective To investigate the release pattern of there cytokines in MODS patients and the effect of CVVH on prognosis.Methods 50 patients with MODS were randomized into two groups.The treatment groups was treated with CVVH in addition to the conventional treament.Blood samples of two groups were collected at 0,12,24,48,72,96,and 168 hrs after admission to measure the plasma concentrations of TNF α,IL 1β,IL 6.Blood and ultrafiltrate samples of the treatment group were collected separately befor and after CVVH and were frozen at 40℃ below zero for chemical examinattion.Results The time of appearance of the high concentrations of TNF α and IL 1β were different.The peaks developed early in the treatment group but appeared late in the control group.CVVH could bring forward the peaks of two cytokines but did no affect the plasma concentrations.Three cytokines were examined in all patientsultrafiltrate.Hemodynamic and oxygenation capacity in the treatment group was superior to the control group.Case fatality rate and estimated mortality were lower compared to the control group.Conclusions CVVH treatment in the early stage of MODS patients can decrease or break partly stop the release of cytokines and can improve prognosis. [