摘要
目的研究不同治疗剂量的高容量血液滤过（HVHF）对重症脓毒症患者外周血中炎性介质表达水平的影响。方法83例重症脓毒症患者，依血液滤过治疗剂量随机分为A组28例[60ml／（kg·h）]、B组28例[80ml／（kg·h）]、C组27例[100ml／（kg·h）]，采用ELISA法检测治疗前和治疗后2．4、6、8、10h患者血浆中TNF—α、IL-1、IL-8的水平，同时观察每个时间点的APACHEⅢ评分变化。结果治疗后APACHEIII评分均下降，差异有统计学意义（P〈0．05），三组之间下降情况比较差异无统计学意义（P〉0．05）；患者血浆TNF-α、IL-1、IL-8水平均逐渐降低，其中TNF-α、IL-1、IL-8在治疗后2．4、6h均明显低于治疗前水平，差异有统计学意义（P〈0．05）；在治疗后8、10h，TNF-α、IL-1、IL-8水平均有轻度上升，但仍显著低于治疗前水平（P〈0．05）。三组各时间点血浆TNF-α、IL-1、IL-8水平呈现随血液滤过治疗剂量的增大而降低的趋势；其中C组炎性介质水平均显著低于A组，差异有统计学意义（P〈0．05）。结论高容量血液滤过治疗可降低重症脓毒症患者外周血中炎性介质水平和APACHEIn评分，随着高容量治疗的剂量增加血浆炎性介质水平降低明显。
Objective To investigate the expression of pro-inflammatory mediator in peripheral blood of patients with severe sepsis treated by different therapeutic dose of high-volume hemofiltration （HVHF）. Methods According to the standard of severe sepsis, 83 cases were randomly divided into three groups, A group [60 ml/（kg·h）], B group [80 ml/（kg·h）], C group[100 ml/（kg·h）], respectively. The levels of TNF-α, IL-1, IL-8 in plasma of patients were measured by enzyme-linked immunosorbent assay （ELISA） before treatment and at 2, 4, 6, 8, 10 h after treatment, and the grades of APACHE Ⅲ were evaluated at every time-point simultaneously. Results The grades of APACHE Ⅲ were lower after treatment than those before treatment （P 〈 0.05）, but the decreases between every group had no significant deviation （P 〉 0.05 ）. The levels of TNF- α, IL-1, IL-8 in plasma of patients were all decreased gradually after treatment. Compared with those before treatment, the levels of TNF- α ,IL-1 and IL-8 at 2, 4 and 6 h after HVHF were obviously decreased （P 〈 0.05）. The levels of TNF- α, IL-1 and IE-8 were lightly increases at 4 and 6 h after HVHF, but they were lower that those before treatment （P 〈 0.05 ）. At every time-point, the levels of TNF- α, IL-1, IL-8 trended to decrease following the increase of displacement liquid volume, the mean levels of pro-inflammatory mediator in C group were markedly reduced compared with the levels in A group （P 〈 0.05）. Conclusion HVHF can decrease the levels of pro-inflammatory mediator in peripheral blood of patients with severe sepsis and the grades of APACHE Ⅲ, the more the therapeutic dose of HVHF, the lower the levels of pro-inflammatory mediator.
出处
《中国医师进修杂志》
2009年第6期8-10,共3页
Chinese Journal of Postgraduates of Medicine
关键词
血液滤过
脓毒症
炎性介质
Hemofiltration
Sepsis
Pro-inflammatory mediator
