连续性血液透析滤过治疗肠穿孔腹膜炎SIRS幼猪疗效观察

目的：全身炎症反应综合征（SIRS）是各种原因引起多脏器功能障碍综合征的共同通路，目前临床缺乏有效的治疗措施。该研究旨在对肠穿孔腹膜炎诱导的SIRS幼猪行早期连续性血液透析滤过，观察SIRS动物的体温、心率、呼吸、血压、血气分析和外周血细胞计数，为临床治疗提供实验依据。方法：12只上海种小白猪，体重7~9 kg，雌雄不限。随机分为2组：对照组（n=6）；治疗组（n=6，连续性血液透析滤过，CVVHDF）。以盲肠穿孔术诱导SIRS，造模成功后治疗组行CVVHDF 6 h，血流速度20 mL/min，透析液速度600 mL/h，置换液速度300 mL/h，零平衡。于动物基础状态、成模时、成模后2，4，6 h分别记录两组动物的心率、呼吸、血压、体温、外周血细胞计数和血气分析结果。结果：所有动物经造模后均出现心率、呼吸频率上升，血压、动脉血氧分压、白细胞计数下降。成模时对照组动物心率和呼吸增快在6 h内持续保持较高水平；治疗组动物成模2 h后心率下降，6 h后呼吸频率下降与对照组相比差异有显著性，P<0.05。对照组动物成模4 h后平均动脉压下降，与治疗组比较差异有显著性，P<0.05。两组动物成模后动脉血氧分压均较基础状态降低，6 h内对照组动物保持低水平，治疗组动物动脉血氧分压有上升趋势，但组间差异无显著性。实验中动物体温及外周血细胞计数变化组间比较差异无显著性。结论：早期CVVHDF可稳定肠穿孔腹膜炎诱导的SIRS幼猪血流动力学，改善血氧分压，可能对改善疾病预后有益。［中国当代儿科杂志，2007，9（3）：237-240］

Therapeutic effect of continuous veno-venous hemodiafiltration on systemic inflammatory response syndrome induced by cecum perforate peritonitis in piglets

Objective Most of the therapeutic strategies for systemic inflammatory response syndrome (SIRS) is not effective. This study was to investigate the effect of continuous veno-venous hemodiafiltration (CVVHDF) on SIRS induced by cecum perforate peritonitis in piglets.Methods Twelve piglets (weighing 7-9 kg) were randomly divided into two groups:control and CVVHDF (n=6). The piglets of both groups were subjected to a cecum puncture to induce peritonitis which caused SIRS. After SIRS occurred the piglets of the CVVHDF group immediately received the CVVHDF therapy for 6 hrs, with a blood flow rate of 20 mL/min, a replacement rate of 300 mL/h, and a dialysis rate of 600 mL/h. The heart rate (HR), mean artery blood pressure (MABP), respiratory rate (RR), arterial blood gas analysis and blood cells count were measured and recorded at baseline and onset of SIRS, and 2, 4 and 6 hrs after SIRS occurred.Results When SIRS occurred, the HR and RR increased and the MABP, artery oxygen pressure (PaO2) and the count of white cells decreased in both groups. The HR of the CVVHDF group decreased significantly at 2 hrs (P< 0.05) and remained lower until 6 hrs after CVVHDF therapy (P< 0.01) compared with that of the control group. The RR of the CVVHDF group was significantly lower than that of the control group 6 hrs after CVVHDF therapy (P< 0.05). The MABP of the CVVHDF group increased significantly 4 and 6 hrs after therapy compared with that of the control group (P< 0.01, P< 0.05 respectively). There were no significant differences in temperature, PaO2 and blood cells count between the two groups during the experiment.Conclusions CVVHDF has a positive effect on hemodynamics in piglets with SIRS induced by cecum perforate peritonitis.