连续性血液滤过治疗的置换量对细胞因子的影响

目的针对多器官功能障碍综合征（MODS）患者,探讨连续性血液滤过（CVVH）治疗的置换量对清除细胞因子的影响。方法18例接受CBP治疗的MODS患者随机分为置换液量〈35 ml·kg^-1· h^-1组（A组,6例）,置换液量45 ml·kg^-1· h^-1组（B组,6例）,置换液量〉60 ml·kg^-1· h^-1组（C组,6例）。在治疗前,治疗后24 h4、8 h、72 h观察血浆中肿瘤坏死因子-α（TNF-α）,白细胞介素-1β（IL-1β）,白细胞介素-10（IL-10）水平。结果治疗24 h后,B组和C组TNF-α、IL-1β水平下降（P〈0.05或P〈0.01）,与A组相比,差异显著（P〈0.05或P〈0.01）,各组IL-10水平较治疗前无统计学变化。结论针对MODS患者,45 ml·kg^-1· h^-1以上置换量连续性血液滤过治疗可以清除多种细胞因子,改善病情。

Effects of different doses in continuous hemofiltration on clearing plasma cytokines

Objective To investigate the effects of different doses in continuous veno venous hemofiltration （CVVH）on plasma cytokines in patients with multiple organ dysfunction syndrome（MODS）. Methods All of eighteen patients met the criteria of MODS and were treated with CVVH. Patients were randomly assigned ultrafiltrationat every hour〈35 ml·kg^-1· h^-1（group A,n=6）, 45 ml·kg^-1· h^-1 （group B, n=6）,〉60 ml·kg^-1· h^-1 （group C, n=6）. The 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 24 hours of hemofiltration, plasma concentrations of tumor necrosis factora（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 CVVH and post-CVVH. Conclusion CVVH reaching at least every hour 45 ml ·kg^-1· h^-1 could remove some cytokines in MODS patients and improve clinic conditions.