连续性静脉-静脉血液滤过对多器官功能障碍综合征患者血浆细胞因子水平的影响

目的观察连续性静脉．静脉血液滤过（CVVH）对多器官功能障碍综合征（MODS）患者血浆细胞因子TNF-α、IL-1、IL-6、IL-8水平的影响。方法选择MODS患者22例,行CVVH治疗,取治疗前后动脉血做血气分析,取静脉血和滤出液检测有关细胞因子水平。在开始行CVVH前及CVVH治疗后1h．4h、8h分别测量心率和平均动脉压。结果22例患者CVVH治疗后血浆TNF-α、IL-1水平明显下降（P〈0．05）。超滤液中未检出TNF-α,但有较高浓度的IL-1、IL-6和IL-8。与CVVH前比较,患者心率显著下降（P〈0．05）,平均动脉压和氧合指数明显升高（P〈0．05）。CVVH治疗后患者的APACHEⅡ评分显著下降,其下降与置换液速度呈正相关。死亡患者置换液速度与存活患者置换液速度有显著差异（P〈0．05）。能够被CVVH有效清除的细胞因子与置换液速度呈正相关（P〈0．05）。结论CVVH可清除MODS患者血浆中部分细胞因子,并可改善患者血流动力学及氧合功能。加大置换液速度能更好地清除外周血细胞因子,并改善预后。

Effect of continuous veno-venous hemofiltration on the plasma level of cytokines in patients with multiple organ dysfunction syndrome

OBJECTIVE: To investigate the effect of CVVH on the plasma levels of TNF-alpha, IL-1, IL-6, IL-8 in patients with multiple organ dysfunction syndrome (MODS). METHODS: Twenty-two patients with MODS were treated with continuous veno-venous hemofiltration (CVVH), venous and arterial blood samples were taken at 0, 1, 4, 8 hour following CVVH and ultrafiltration fluid samples were taken at 8 hour following CVVH. Arterial blood samples were used for blood gas analysis, venous blood samples and ultrafiltration fluid were used to measure the levels of cytokines by ELISA. RESULTS: The plasma levels of TNF-alpha and IL-1 were significantly decreased following CVVH (P < 0.05). The IL-1, IL-6, IL-8 were detected in the ultrafiltration fluid and TNF-alpha was not. Heart rate decreased and mean arterial pressure (MAP) increased significantly 4 hrs after CVVH (P < 0.05). PaO(2)/FiO(2) increased significantly (P < 0.05). The APACHE II scores reduced after CVVH (P < 0.05). The reduction of APACHE II score and the elimination of cytokines were positively correlated with ultrafiltration flow rates CONCLUSIONS: CVVH can remove some cytokines in plasma, reduce APACHEII score and improve hemodynamics and oxygenation in MODS. Moreover, higher volume hemofiltration has better effect on the elimination of cytokines and can further improve the prognosis of MODS.