CAJ | 학술논문

目的研究不同治疗剂量的高容量血液滤过(HVHF)对重症脓毒症患者外周血中炎性介质表达水平的影响.方法 83例重症脓毒症患者,依血液滤过治疗剂量随机分为A组28例[60ml/(kg·h)]、B组28例[80ml/(kg·h)]、C组27例[100ml/(kg·h)],采用ELISA法检测治疗前和治疗后2、4、6、8、10 h患者血浆中TNF-α、IL-1、IL-8的水平,同时观察每个时间点的APACHE Ⅲ评分变化.结果治疗后APACHE Ⅲ评分均下降,差异有统计学意义(P<0.05),三组之间下降情况比较差异无统计学意义(P>0.05);患者血浆TNF-α、IL-1、IL-8水平均逐渐降低,其中TNF-α、IL-1、IL-8在治疗后2、4、6 h均明显低于治疗前水平,差异有统计学意义(P<0.05);在治疗后8、10 h,TNF-α、IL-1、IL-8水平均有轻度上升,但仍显著低于治疗前水平(P<0.05).三组各时间点血浆TNF-α、IL-1、IL-8水平呈现随血液滤过治疗剂量的增大而降低的趋势;其中C组炎性介质水平均显著低于A组,差异有统计学意义(P<0.05).结论高容量血液滤过治疗可降低重症脓毒症患者外周血中炎性介质水平和APACHEⅢ评分,随着高容量治疗的剂量增加血浆炎性介质水平降低明显.
목적 연구불동치료제량적고용량혈액려과(HVHF)대중증농독증환자외주혈중염성개질표체수평적영향.방법 83례중증농독증환자,의혈액려과치료제량수궤분위A조28례[60ml/(kg·h)]、B조28례[80ml/(kg·h)]、C조27례[100ml/(kg·h)],채용ELISA법검측치료전화치료후2、4、6、8、10 h환자혈장중TNF-α、IL-1、IL-8적수평,동시관찰매개시간점적APACHE Ⅲ평분변화.결과 치료후APACHE Ⅲ평분균하강,차이유통계학의의(P<0.05),삼조지간하강정황비교차이무통계학의의(P>0.05);환자혈장TNF-α、IL-1、IL-8수평균축점강저,기중TNF-α、IL-1、IL-8재치료후2、4、6 h균명현저우치료전수평,차이유통계학의의(P<0.05);재치료후8、10 h,TNF-α、IL-1、IL-8수평균유경도상승,단잉현저저우치료전수평(P<0.05).삼조각시간점혈장TNF-α、IL-1、IL-8수평정현수혈액려과치료제량적증대이강저적추세;기중C조염성개질수평균현저저우A조,차이유통계학의의(P<0.05).결론 고용량혈액려과치료가강저중증농독증환자외주혈중염성개질수평화APACHEⅢ평분,수착고용량치료적제량증가혈장염성개질수평강저명현.
Objective To investigate the expression of pro-irtilammatory mediator in peripheral blood of patients with severe sepsis treated by different therapeutic dose of high-volume hemofiltration (HVHF). Methods According to the standard of severe sepsis, 83 cases were randomly divided into three groups, A group [60 ml/(kg·h)], S group[80 ml/(kg·h)], C group[100 ml/(kg·h)], respectively. The levels of TNF-α, IL-1, IL-8 in plasma of patients were measured by enzyme-linked immunosorbent assay (ELISA) before treatment and at 2, 4, 6, 8, 10 h after treatment, and the grades of APACHEⅢ were evaluated at every time-point simultaneously. Results The grades of APACHEⅢ were lower after treatment than those before treatment (P<0.05), but the decreases between every group had no significant deviation (P>0.05). The levels of TNF-Ⅲ, IL-1, IL-8 in plasma of patients were all decreased gradually after treatment. Compared with those before treatment, the levels of TNF-α,IL-1 and IL-8 at 2, 4 and 6 h after HVHF were obviously decreased (P<0.05). The levels of TNF-α, IL-1 and IL-8 were lightly increases at 4 and 6 h after HVHF, but they were lower that those before treatment (P<0.05). At every time-point, the levels of TNF-α, IL-1, IL-8 trended to decrease following the increase, of displacement liquid volume, the mean levels of pro-inflammatory mediator in C group were markedly reduced compared with the levels in A group (P<0.05). Conclusion HVHF can decrease the levels of pro-inflammatory mediator in peripheral blood of patients with severe sepsis and the grades of APACHEⅢ, the more the therapeutic dose of HVHF, the lower the levels of pro-inflammatory mediator.