连续性血液净化对合并ARF的MODS患者炎性因子和凝血功能的改变

目的探讨连续性静脉-静脉血液滤过(CVVH)技术对合并急性肾功能衰竭(ARF)的多器官功能障碍综合征(MODS)患者体内炎性因子的清除作用及对凝血纤溶的影响,同时观察连续性血液净化(CBP)对患者肾功能、血流动力学的影响和预后的影响。方法选择合并ARF行CVVH治疗的MODS患者106例,CVVH治疗前及治疗后6h、12h、24h,分别检测TNF-α、IL-6、IL-10、血浆纤溶酶原活性抑制物-1(PAI-1)浓度;血液电解质及肾功能;血气分析、pH值、动脉血氧分压、动脉血二氧化碳分压;体温、心率、呼吸、平均动脉压、中心静脉压。结果 106例患者CBP治疗后TNF-α水平显著低于治疗前(P<0.05);血清IL-6,IL-10水平在CBP治疗后均下降,但较治疗前差异无统计学意义(P>0.05);MODS组血清PAI-1、CRP浓度明显高于健康人(P<0.05);随着CBP时间的延长下降逐渐减小,与CBP前比较差异无统计学意义(P>0.05);CVVH前后BUN、Scr、血清K+和HR比较,差异有统计学意义(P<0.05);血清Na+、Cl-、Glu、pH值、PaCO2,差异无统计学意义(P>0.05)。结论 CBP能清除合并ARF的MODS患者血清中多种炎性因子,对凝血纤溶紊乱有改善。CBP过程中血流动力学平稳,对患者有良好的治疗作用。

The effect of continuous veno-venous hemofiltration on coagulation/fibrinolysis and the clearance of inflammatory factors in patients with multiple organ dysfunction syndrome complicated by acute renal failure

Objective To investigate the effect of continuous veno-venous hemofiltration （CVVH） on coagulation/fibrinolysis and clearance of inflammatory factors in patients with multiple organ dysfunction syndrome （MODS） complicated by acute renal failure （ARF）, meanwhile, to observe the effect of continuous blood purification （CBP） on patients＇ renal function, hemodynamic and prognosis. Methods 106 patients with MODS complicated by ARF who received CVVH in ICU were enrolled in the study. The levels of TNF-a, IL-6, IL-10, activity inhibitor 1 of plasma profibrinolysin were detected, and blood electrolyte, renal function, blood gas analysis, pH value, arterial PO2, PaCO~, body temperature, heart rate, respiration, mean arterial pressure and central venous pressure were measured for all the patients before CVVH treatment and 6h, 12h,24h after CVVH treatment. Results The serum levels of TNF-ct were significantly decreased after CBP treatment （ P 〈 0. 05 ）. The serum levels of IL-6 and IL-10 were reduced after CBP treatment, however, as compared with those before treatment, there were no significant differences （ P 〉 0.05 ）, The levels of PAI-1 and CRP in patients with MODS were significantly higher than those of healthy subjects （ P 〈 0.05 ）, with the time prolongation of CBP, the decrease degree was gradually reduced, and there was no significant difference, as compared with that before CBP treatment （ P 〉 0.05）. After CVVH treatment, there were significant differences in the levels of BUN, Scr, serum K ~ , HR, as compared with those before CVVH treatment （ P 〈 0.05 ） , however, there were no significant differences in the levels of serum Na ＋ , Cl-, Glu, pH, PaCO2, as compared with those before treatment （ P 〉 0.05 ）. Conclusion CBP can remove multiple inflammatory factors and improve the abnormality of coagulation/fibrinolysis in patients with MODS complicated by ARF, furthermore, during CBP, the hemodynamics is stable, which has better therapeutic effect.