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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1 h、4 h、8 h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。
Objective To observe the effect of continuous veno-venous hemofiltration (CVVH) on the levels of plasma cytokines TNF-α, IL-1, IL-6 and IL-8 in patients with multiple organ dysfunction syndrome (MODS) Methods Twenty-two patients with MODS were selected and treated with CVVH. Blood samples were taken from arterial blood before and after treatment. Venous blood and filtrate were used to detect cytokine levels. Heart rate and mean arterial pressure were measured at 1 h, 4 h, and 8 h after CVVH was started and after CVVH treatment. Results The plasma levels of TNF-α and IL-1 in CVVH after treatment in 22 patients were significantly decreased (P <0.05). No TNF-α was detected in the ultrafiltrate, but higher levels of IL-1, IL-6 and IL-8 were detected. Compared with the pre-CVVH, heart rate decreased significantly (P <0.05) and mean arterial pressure and oxygenation index increased significantly (P <0.05). The APACHE II score decreased significantly after CVVH treatment, and the decrease was positively correlated with the replacement fluid velocity. There was a significant difference (P <0.05) between the rate of replacement fluid and the rate of fluid replacement in survivors. Cytokines that were effectively cleared by CVVH were positively correlated with the rate of replacement fluid (P <0.05). Conclusion CVVH can clear some of the plasma cytokines in patients with MODS and can improve hemodynamics and oxygenation function. Increase the replacement fluid velocity can better remove peripheral blood cytokines, and improve the prognosis.