连续血液滤过对严重脓毒症患者免疫抑制状态的影响

目的：探讨连续性静-静脉血液滤过（continuous venovenous hemofiltration，CVVH）对严重脓毒症患者血流动力学和外周血辅助性T细胞亚群Th1/Th2平衡的影响。方法：前瞻性观察应用CVVH治疗18例严重脓毒症患者，于CVVH治疗前和治疗后4、8h抽取静脉血应用流式细胞仪检测外周血辅助性T细胞亚群Th1／Th2比值变化，同时观察生化指标、血流动力学变化。结果：18例患者CVVH治疗后血清BUN、Scr较治疗前均呈下降趋势（P〈0．01），MAP显著上升（P〈0．01）。而多巴胺、去甲肾上腺素用量显著降低护〈0．01），Th1／Th2比值呈上升趋势，差异具有统计学意义（P〈0．05或P〈0．01）。结论：CVVH能改善严重脓毒症患者血流动力学及免疫麻痹状态。

Effects of Continuous Hemofiltration on Immunosuppression in Severe Sepsis

Objective: To study the effects of continuous venovenous hemofiltration (CVVH) on the hemodynamics and the balance of Th1-Th2 in severe sepsis. Methods: Eighteen severe septic patients were treated with CVVH. Th1/Th2 of peripheral T helper T cell were measured before and 4 and 8h after CVVH treatment. Blood biochemical indexes and hemodynamics parameters were observed. Results: BUN and Scr decreased significantly (P < 0.01), MAP increased significantly (P < 0.01), the dose of dopamine and norepinephrine decreased significantly (P < 0.01), and Th1/Th2 increased after CVVH treatment in 18 patients. The differences were significant (P< 0.05 or P< 0.01). Conclusion: CVVH can improve the hemodynamics and the immunosuppression in severe septic.