As an initial factor,sepsis and multiple organ dysfunction syndrome(MODS)caused by sepsis are the principal causes of death in burned patients. In this report, we measured the levels of tumor necrosis factor (TNF)-α,...As an initial factor,sepsis and multiple organ dysfunction syndrome(MODS)caused by sepsis are the principal causes of death in burned patients. In this report, we measured the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in severely burned patients with sepsis after the initiation of continuous vein-vein hemodiafiltration (CVVHDF) to evaluate the clinical usefulness of CVVHDF on the removal of key mediators. The vital sign indices, such as the heart rate (HR), respiration (R) and central venous pressure (CVP), were recorded at 0 and 42 h in each group. Further, the laboratory examinations indexes, such as the white blood cel count, blood sugar, se-rum sodium, blood urea nitrogen and serum creatinine, were detected in venous blood samples. Twenty-two severely burned patients suffering from sepsis were randomized into the control group (A, n = 11) and the experimental group (B, n = 11). The patients in group A underwent conventional treatment, and those in group B received conventional+CVVHDF treatment. The vital signs, such as the HR, R, and CVP, and laboratory examination indices, such as the blood cel count, blood sugar, serum sodium, blood urea nitrogen, and serum creatinine, dropped significantly in group B compared with those in group A at 42 h (P < 0.05). The plasma levels of TNF-α, IL-6 and IL-8 were measured at 0, 12, 18, 24, 36 and 42 h after the start of CVVHDF and at the same time points after the patients were diagnosed with sepsis in group A. The plasma levels of TNF-α in group B decreased by 32% at 18 h after the start of CVVHDF and decreased by 43%at 42 h after the start of CVVHDF;however, these levels were increased compared with the normal values (P < 0.01). The plasma levels of IL-6 decreased at 18 h after the start of CVVHDF (0.274 ± 0.137 ng/ml). Fol owing a brief increase at 24 h, the plasma levels of IL-6 again decreased continuously until the end of the investigation (0.192 ± 0.119 ng/ml). The plasma levels of IL-8 in group B decreased by 56% at 18 h after the start of CVVHDF, but they were increased compared with the normal values (P < 0.01). The plasma levels of IL-8 in group B decreased by 70% at 42 h after the start of CVVHDF, but they were increased compared with the normal values (P < 0.01). The MODS incident was 4 of 11 in group A compared with 1 of 11 in group B (P < 0.01). In conclusion, CVVHDF can effectively reduce the levels of TNF-α, IL-6 and IL-8 as wel as the MODS incidence in patients with serious burns.展开更多
目的探讨连续性血液净化(CBP)早期治疗肺外源性ARDS中的临床价值。方法选取2009年8月至2010年12月间同一治疗组收治的急性生理学及慢性健康状况评价(APACHEⅡ)评分在15～20分之间,氧合指数(PaO2/FiO2)在100～200 mm Hg之间的肺外源性急...目的探讨连续性血液净化(CBP)早期治疗肺外源性ARDS中的临床价值。方法选取2009年8月至2010年12月间同一治疗组收治的急性生理学及慢性健康状况评价(APACHEⅡ)评分在15～20分之间,氧合指数(PaO2/FiO2)在100～200 mm Hg之间的肺外源性急性呼吸窘迫综合征(ARDS)患者35例,16例行连续性血液净化治疗,为CBP组;19例未予CBP治疗,为对照组。CBP组:采用连续性静静脉血液透析滤过(CVVHDF)模式,置换液流速1.5 L/h,透析液流速1.5 L/h,血流速度100～200 mL/min,治疗时间为72 h,统计学分析患者血液净化干预72 h NICO和PICCO相关指标变化及预后情况。结果 CBP组死亡率为6.3%,对照组死亡率为36.8%(P<0.05)。CBP组的肺毛细血管血流量(PCBF)、肺动态顺应性(Cdyn)、分钟CO2排出量(VCO2)、肺泡通气量(MValv)、平均气道压(Pm)、气道峰压(PIP)、气道阻力(Raw)、呼吸浅快指数(RSBI)、死腔通气/潮气量(Vd/Vt)、血管外肺水(EVLW)、肺血管通透性(PVPI)及PaO2/FiO2改善时间均明显早于对照组,效果也明显优于对照组,72 h的结果比较差异有统计学意义(P<0.05);平均动脉压(Apm)、心排指数(CI)及中心静脉压(CVP)未见明显变化(P>0.05)。结论在肺外源性ARDS治疗中,早期血液净化治疗可以减轻体内炎症反应,同时减少PCBF、EVLW,改善肺的顺应性,增加肺泡通气量,从而改善氧合指数,改善预后,且不会影响心功能和循环稳定,安全可靠。展开更多
文摘As an initial factor,sepsis and multiple organ dysfunction syndrome(MODS)caused by sepsis are the principal causes of death in burned patients. In this report, we measured the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in severely burned patients with sepsis after the initiation of continuous vein-vein hemodiafiltration (CVVHDF) to evaluate the clinical usefulness of CVVHDF on the removal of key mediators. The vital sign indices, such as the heart rate (HR), respiration (R) and central venous pressure (CVP), were recorded at 0 and 42 h in each group. Further, the laboratory examinations indexes, such as the white blood cel count, blood sugar, se-rum sodium, blood urea nitrogen and serum creatinine, were detected in venous blood samples. Twenty-two severely burned patients suffering from sepsis were randomized into the control group (A, n = 11) and the experimental group (B, n = 11). The patients in group A underwent conventional treatment, and those in group B received conventional+CVVHDF treatment. The vital signs, such as the HR, R, and CVP, and laboratory examination indices, such as the blood cel count, blood sugar, serum sodium, blood urea nitrogen, and serum creatinine, dropped significantly in group B compared with those in group A at 42 h (P < 0.05). The plasma levels of TNF-α, IL-6 and IL-8 were measured at 0, 12, 18, 24, 36 and 42 h after the start of CVVHDF and at the same time points after the patients were diagnosed with sepsis in group A. The plasma levels of TNF-α in group B decreased by 32% at 18 h after the start of CVVHDF and decreased by 43%at 42 h after the start of CVVHDF;however, these levels were increased compared with the normal values (P < 0.01). The plasma levels of IL-6 decreased at 18 h after the start of CVVHDF (0.274 ± 0.137 ng/ml). Fol owing a brief increase at 24 h, the plasma levels of IL-6 again decreased continuously until the end of the investigation (0.192 ± 0.119 ng/ml). The plasma levels of IL-8 in group B decreased by 56% at 18 h after the start of CVVHDF, but they were increased compared with the normal values (P < 0.01). The plasma levels of IL-8 in group B decreased by 70% at 42 h after the start of CVVHDF, but they were increased compared with the normal values (P < 0.01). The MODS incident was 4 of 11 in group A compared with 1 of 11 in group B (P < 0.01). In conclusion, CVVHDF can effectively reduce the levels of TNF-α, IL-6 and IL-8 as wel as the MODS incidence in patients with serious burns.
