连续性静-静脉血液滤过对创伤后MODS病人血清NO与TNF-α浓度及近期预后的影响

Effects of continuous veno-venous hemofiltration on the serum levels of NO and TNF-α and short-term prognosis in patients with post-traumatic multiple organ dysfunction syndrome

目的 探讨连续性静 静脉血液滤过 (CVVH)对创伤后多器官功能障碍综合征 (MODS)病人血清一氧化氮 (NO)与α 肿瘤坏死因子 (TNF α)浓度及近期预后的影响。方法 17例创伤后MODS病人一经确诊即行床边CVVH。CVVH之前和之后 6h取血和超滤液检测NO与TNF α浓度。结果 CVVH干预后6h血清NO浓度峰值与TNF α浓度峰值与CVVH干预之前比较均有显著性统计学意义 ,CVVH干预组住院病死率明显低于对照组 ,滤过液中也能检测到较高浓度的NO和TNF α。结论 CVVH能够有效清除创伤后MODS病人血中过高的NO和TNF α并明显改善近期预后。

Objective To investigate the ef fects of continuous veno venous hemofiltration(CVVH) on the serum levels of NO and TNF α and short term prognosis in patients with post traumatic multiple organ dysfunction syndrome(MODS).Methods After being accurately diagnosed,seventeen patients with post traumatic MODS received CVVH using Baxt er BM25 machine and gambro FH66 polysulfone membrane dialyzer.Serum were separat ed and reserved in refrigerator(-40℃) for testing the levels of NO and TNF α .Results Serum NO Levels and TNF α peak value declined obviou sly in MODS cases after CVVH treatment(NO:248.235±76.053 vs 168.294±86.402,P<0.01,TNF α:253.235±117.578 vs 155.235±97.296,P<0.01).The mortality in CVVH group was generally lower than that in Non CVVH group(65.00% vs 29.41%,P=0.03).There was higher serum concentr ation of NO(98.41±52.39 μmol/L) and TNF α(54.95±51.22 ng/L) in fluid filt ered.Conclusion CVVH treatment could obviously reduce serum lev el of TNF α and NO,improve the progress of MODS and reduce the mortality of MO DS.