重症急性胰腺炎患者HV-CVVH清除细胞因子的作用

Clearance effects of high volume continuous veno-venous hemofiltration on cytokines in patients with severe acute pancreatitis

目的 :利用高容量的连续性静脉 静脉血液滤过(HV CVVH)治疗重症急性胰腺炎合并肾功能衰竭患者 ,探讨HV CVVH在清除炎性介质方面的作用 .方法 :重症急性胰腺炎合并肾功能衰竭患者 1 3例 ,其APACHEIII评分为 (2 3± 5 ) .全部患者进行连续性静脉 静脉血液滤过 (CVVH)治疗 .根据置换率不同将患者分为两组 ,置换率为 2L/h者 8例 (I组 ) ,置换率为 4L/h者 (II组 ) 5例 .在治疗的 0 ,1 ,2 ,3,6和 2 4h分别自滤器后取血液 5mL ,离心分离血浆 .用夹心ELISA法测定血浆中的炎性细胞因子 (TNF α ,IL 6和IL 1 0 )的含量 .结果 :CVVH治疗 3h内 ,血中全部细胞因子的浓度下降速度比较快 ,两组比较 ,高容量组 (II组 )这一变化表现得更为明显 .TNF α和IL 1 0治疗至 3h后的下降速度减缓 .治疗过程中患者血液动力学稳定 ,APACHEIII评分结果显示CVVH治疗前后II组患者病情改善显著 .结论 :HV CVVH在清除重症急性胰腺炎合并肾功能衰竭患者的炎性细胞因子方面效果明显 ,并且对血液动力学影响小 。

AIM: To investigate the role of high volume continuous veno veous hemofiltration (HV CVVH) in the cytokines removal in patients with severe acute pancreatitis. METHODS: Thirteen severe acute pancreatitis patients who had renal failure and the APACHE III scores of 23±5 were treated with continuous veno venous hemofiltration (CVVH) and were divided into two groups according to the different substitution rates: Group I (2 L/h, n =8) and group II (4 L/h, n =5). The blood samples, drawn from the postfilter at 0, 1, 2, 3, 6, 24 h, were immediately centrifuged. Cytokines (TNF α, IL 6 and IL 10) in serum were analyzed with ELISA. RESULTS: The levels of all cytokines declined quickly 3 h after CVVH, which was more significant in group II. Three hours after CVVH, the serum levels of TNF α and IL 10 declined slowly. The hemodynamics of patients was stable. APACHE III scores showed that the conditions of patients in group II were improved significantly after CVVH. CONCLUSION: HV CVVH is very effective in cytokine removal in severe acute pancreatitis patients with renal failure and can maintain stable hemodynamic parameters, which may help alleviate the symptoms of patients.