连续性静脉-静脉血液滤过在重症多发性创伤治疗中的应用

目的探讨连续性静脉-静脉血液滤过（CVVH）在阻断重症多发性创伤（SMI）所致的全身炎性反应综合征（SIRS）向多器官功能障碍综合征（MODS）发展中的作用及机制。方法58例重症多发性创伤伤员随机分为试验组（n=31）和对照组（n=27），并选20名健康体检者为健康组。对照组予常规综合治疗，试验组在常规综合治疗的同时加CVVH治疗。两组同时检测血清白介素-6（IL-6）、白介素-Iβ（IL—Iβ）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）水平，并观察SIRS临床指标的变化；健康组检测结果为正常对照。结果试验组T、RR、HR及WBC改善情况均明显优于对照组（P〈0．05或P〈0．01）；血清CRP、IL—Iβ、IL-6和TNF-α水平均较对照组下降更为明显（P〈0．01）；转为MODS明显减少（P〈0．05），死亡率明显降低（P〈0．05）。结论CVVH可通过下调炎症介质，调控机体炎性反应，阻断重症多发性创伤所致的SIRS向MODS发展。

Continuous renal replacement therapy in treatment of patients with severe multiple injury

Objective To evaluate the value of continuous vent*venous hemofiltration(CVVH) in hindering systemic inflammatory response syndrome(SIRS) of severe multiple injury to proceed to multiple organ dysfunction syndrome(MODS). Methods 58 patients were randomly divided into routine group(n =31) and CVVH group(n = 27). Both groups were given routine treatment,while the patients in the CVVH group were given CVVH in addition. Additionally ,20 healthy persons were enrolled as normal group. The condition of SIRS were observed, and the serum C reactive protein(CRP)., tumor necrosis factor-α(TNF-α) , interleuldn-6 (IL-6), interleuldn- Ⅰβ(IL- Ⅰβ) levels were measured before and after treatment in CVVH group,routine group and in normal group at the time of health examina-tion. Results Temperature(T), respiration rate (RR) , heart rate (HR) and white blood cell (WBC) were reduced significantly in CVVH group(P < 0.05 or P < 0.01). The serum CRP, TNF-α, IL- Ⅰβ and IL-6 levels of CVVH group were reduced significantly(P <0.01). The number of patients with duration of SIRS were fewer and the incidence of MODS was lower in CVVH group than those in routine group(P <0.05) ,and the fatality rate was reduced significant-ly in CVVH group(P < 0.05). Conclusion CVVH would significantly improve the inflammatory symptom and signs of SIRs,inhibit the production of inflammatory cytokines in the treatment of SIRS. It can effectively prevent SIRS of severe multiple injury to proceed to MODS.