不同置换量连续性血液净化治疗对多器官功能障碍综合征患者细胞因子的影响

目的探讨不同置换量连续性血液净化（CBP）治疗对多器官功能障碍综合征（MODS）患者细胞因子的影响。方法将18例接受CBP治疗的MODS患者随机分为以下3组：A组6例，置换液量每小时〈35ml／kg；B组6例，置换液量每小时45ml／kg；C组6例，置换液量每小时〉60ml／kg。在治疗前，治疗后24、48、72小时观察急性生理学与慢性健康状况Ⅱ（APEACHEⅡ）评分变化，并测定血浆中肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-10（IL-10）的水平。结果治疗48小时后，B组和C组APEACHE Ⅱ评分明显下降（P〈0．05）；治疗24小时后，B组和C组TNF-α、IL-1β水平下降（P〈0．05或P〈0．01），与A组比较，差异有显著性（P〈0．05或P〈0．01），各组IL-10水平与治疗前比较无显著性差异。结论每小时45ml／kg以上置换量CBP可清除多种细胞因子，改善临床状况。

Effects of different doses in continuous blood purification on plasma cytokines in patients with multiple organ dysfunction syndrome

Objective To investigate the effects of different doses in continuous blood purification （CBP） on plasma cytokines in patients with multiple organ dysfunction syndrome（MODS）. Methods All of eighteen patients fulfilled the criteria of MODS and were treated with CBP. Patients were randomly assigned ultrafiltration volume at every hour 〈 35 ml·kg^-1 （ group A, n = 6 ） ,45ml·kg^-1 （ group B, n = 6 ） , 〉 60ml·kg^-1 （ group C, n = 6 ）. The acute physiology and chronic health evaluation Ⅱ （ APEACHE Ⅱ ） scores were evaluated,and blood samples were taken from the patients at 0 h,24 h,48 h and 72 h during CBP to measure the levels of plasma cytokines. Results After 48 hours of CBP, APEACHE Ⅱ score of group B and group C was significantly lower than those of group A （ P 〈 0.05 ） ; After 24 hours of CBP, plasma concentrations of tumor necrosis factorα （TNF-α） , interleukin-1β（ IL-1β） of group B and group C was significantly lower than those of group A（ P 〈 0.05 or P 〈 0.01 ）. In all groups, there was no significant difference in plasma interleukin-10（IL-10） between pre-CBP and post-CBP. Conclusion CBP reaching at least every hour 45 ml · kg^-1 could remove some cytokines from plasma and improve clinical condition.