连续性静脉-静脉血液透析滤过对多器官功能障碍综合征犬不同溶质的清除作用

目的 观察连续性静脉-静脉血液透析滤过（CVVHDF）对多器官功能障碍综合征（MODS）犬病程中各种溶质的清除，为临床选择连续性肾脏替代治疗（CRRT）治疗方式提供理论依据。 方法 经失血性休克+复苏灌注+内毒素血症建立犬MODS模型, 随机分为MODS组（M组）和MODS+CVVHDF组（M+C组）。采用PRISMA机器行前稀释型CRRT，测定相同透析液及超滤液流量下一氧化氮（NO）、尿素氮（BUN）、血肌酐（Scr）、白细胞介素6 （IL-6）、IL-10、肿瘤坏死因子α（TNF-α）及内毒素（LP）浓度，计算其清除率。 结果 CVVHDF对小分子溶质如NO、BUN、Cr的清除率较高，对大分子物质IL-6、IL-10、TNF-α、LP的清除率较低。且随着各溶质分子量的增加，治疗时间的延长，各溶质的清除率呈现下降趋势。 结论 CVVHDF通过对流与吸附作用可有效清除MODS病程中的大、小分子溶质，是MODS救治中的强有力的支持治疗措施。

Effect of continuous venovenous haemodiafiltration on the clearances of various solutes in multiple organ dysfunction syndrome dogs

Objective To study the effect of continuous venovenous haemodiafiltration (CVVHDF) on the clearances of various solutes in multiple organ dysfunction syndrome (MODS)dogs.Methods Dogs were subjected to hemorrhagic shock plus resuscitation and endotoxemia to set up MODS model,then they were randomly divided into 2 groups: MODS group (M group)and MODS+CVVHDF group (M+C group).A PRISMA pre-dilution system with AN-69 filter was applied.Solute clearance of nitric oxide(NO),urea nitrogen(UN),creatinine (Cr),interleukin-6 (IL-6),interleukin-10 (IL-10),tumor necrosis factor-α (TNF-α) and endotoxin (LP) was determined with same dialysate and ultrafiltrate volume during CVVHDF.The clearance of various solutes (Kd) was calculated by the concentration of the cleared solutes in effluents (E) based on the formula Kd=(ExQE)/P.Results Clearances of NO,UN,Cr were greater than those of IL-6,IL-10,TNF-α,LP during the treatment of CVVHDF.Conclusion CVVHDF could effectively reduce the levels of various solutes in the development of MODS by convection and absorption.