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目的研究高流量血液滤过(HVHF)对全身炎症反应综合征(SIRS)患者炎症介质水平和预后的影响。方法对ICU内31例SIRS患者接收血液滤过治疗,随机分为超滤量60ml·kg-1·h-1的HVHF组(15例)和超滤量35ml·kg-1·h-1的连续性静脉静脉血液滤过(CVVH)组(16例),每次血液滤过治疗时间不少于24h。分别于血液滤过前(T0)、滤过12h(T1)及24h(T2)抽取静脉血检测肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-8,并观察SIRS指标和APACHEⅡ评分。结果 T1时,HVHF组TNF-α、IL-6水平显著下降且低于CVVH组(P<0.05);T2时两组TNF-α、IL-6下降均不明显。两组的IL-8在治疗24h中均缓慢下降。两组治疗后SIRS指标和APACHEⅡ评分均显示明显改善,HVHF组的存活率明显高于CVVH组(P<0.05)。结论 HVHF降低SIRS患者炎症介质的效果较CVVH更为明显。
Objective To investigate the effects of high-flow hemofiltration (HVHF) on inflammatory mediators and prognosis in patients with systemic inflammatory response syndrome (SIRS). Methods Thirty-one patients with SIRS in the ICU were enrolled in this study. Hemofiltration was randomized into HVHF group (15 cases) with ultrafiltration volume of 60ml · kg-1 · h-1 and ultrafiltration volume of 35ml · kg-1 · h-1 Continuous venous venous hemofiltration (CVVH) group (16 cases), each treatment time of hemofiltration of not less than 24h. The levels of tumor necrosis factor alpha (TNF-α), interleukin (IL) -6, and IL-8 were determined by venous blood before filtration (T0), filtration 12h (T1) and 24h SIRS index and APACHE Ⅱ score. Results At T1, the levels of TNF-α and IL-6 in HVHF group were significantly lower than those in CVVH group (P <0.05), while the levels of TNF-α and IL-6 in HVHF group were not significantly decreased at T2. Both groups of IL-8 in the treatment of 24h slow decline. The SIRS index and APACHEⅡscores in both groups showed significant improvement after treatment, and the survival rate in HVHF group was significantly higher than that in CVVH group (P <0.05). Conclusions HVHF is more effective than CVVH in reducing inflammatory mediators in SIRS patients.