中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
11期
819-824
,共6页
陈伟明%陆国平%陆铸今%张灵恩
陳偉明%陸國平%陸鑄今%張靈恩
진위명%륙국평%륙주금%장령은
休克,脓毒性%血液滤过%猪
休剋,膿毒性%血液濾過%豬
휴극,농독성%혈액려과%저
Shock,septic%Hemofiltration%Swine
目的 探讨早期应用不同置换量血液滤过治疗对内毒素诱导的脓毒症休克幼猪血液动力学指标、血浆中炎症介质水平及氧代谢指标的影响.方法 18头幼猪利用随机数字表进行完全随机化分组,分为对照组、血液滤过组(CVVH组)、高容量血液滤过组(HVHF组),每组6头.应用大肠杆菌(O111∶ B4)内毒素静脉注射诱导休克模型产生.于动物基础状态(B0h)、成模(0 h)、成模后2h(2h)、成模后4 h(4 h)、成模后6 h(6 h)分别记录心率、平均动脉压、心输出量、外周血管阻力指数、胸内血容量、血浆炎症介质(IL-6、IL-10、TNF-α)及氧代谢指标.结果 血液滤过治疗两组动物的血液动力学得到一定逆转；其中HVHF组血液动力学改善较CVVH组更显著,4 h[(82±17) mmHg](1 mm Hg =0.133 kPa)、6 h[(80± 12) mm Hg]平均动脉压高于CVVH组[4 h(67±12) mm Hg；6 h(69±14) mm Hg] (P＜ 0.05),4 h[(1736±163) dyne·s·cm-5/m2]、6 h[(1786±171) dyne· s·cm-5/m2]外周血管阻力指数高于CVVH组[4 h(1159±99) dyne· s· cm-5/m2;6h(1196±184)dyne·s· cm-5/m2](P＜0.05);血浆各炎症介质水平治疗两组低于对照组,且6h时TNF-α[(56±9) pg/ml]及IL-6[(175 ±37) pg/ml]水平HVHF组低于CVVH组[TNF-α(67±13) pg/ml；IL-6(281 ±51) pg/ml] (P＜0.05)；氧代谢指标HVHF组氧摄取率在4 h(44％±3％)、6 h(43％±5％)高于CVVH组[4 h(33％±4％)；6 h(31％±3％)](P＜0.05).结论 早期高容量血液滤过较常规剂量有助于降低脓毒症休克幼猪模型的血浆炎症介质水平,同时改善血流动力学,并能改善氧代谢.
目的 探討早期應用不同置換量血液濾過治療對內毒素誘導的膿毒癥休剋幼豬血液動力學指標、血漿中炎癥介質水平及氧代謝指標的影響.方法 18頭幼豬利用隨機數字錶進行完全隨機化分組,分為對照組、血液濾過組(CVVH組)、高容量血液濾過組(HVHF組),每組6頭.應用大腸桿菌(O111∶ B4)內毒素靜脈註射誘導休剋模型產生.于動物基礎狀態(B0h)、成模(0 h)、成模後2h(2h)、成模後4 h(4 h)、成模後6 h(6 h)分彆記錄心率、平均動脈壓、心輸齣量、外週血管阻力指數、胸內血容量、血漿炎癥介質(IL-6、IL-10、TNF-α)及氧代謝指標.結果 血液濾過治療兩組動物的血液動力學得到一定逆轉；其中HVHF組血液動力學改善較CVVH組更顯著,4 h[(82±17) mmHg](1 mm Hg =0.133 kPa)、6 h[(80± 12) mm Hg]平均動脈壓高于CVVH組[4 h(67±12) mm Hg；6 h(69±14) mm Hg] (P＜ 0.05),4 h[(1736±163) dyne·s·cm-5/m2]、6 h[(1786±171) dyne· s·cm-5/m2]外週血管阻力指數高于CVVH組[4 h(1159±99) dyne· s· cm-5/m2;6h(1196±184)dyne·s· cm-5/m2](P＜0.05);血漿各炎癥介質水平治療兩組低于對照組,且6h時TNF-α[(56±9) pg/ml]及IL-6[(175 ±37) pg/ml]水平HVHF組低于CVVH組[TNF-α(67±13) pg/ml；IL-6(281 ±51) pg/ml] (P＜0.05)；氧代謝指標HVHF組氧攝取率在4 h(44％±3％)、6 h(43％±5％)高于CVVH組[4 h(33％±4％)；6 h(31％±3％)](P＜0.05).結論 早期高容量血液濾過較常規劑量有助于降低膿毒癥休剋幼豬模型的血漿炎癥介質水平,同時改善血流動力學,併能改善氧代謝.
목적 탐토조기응용불동치환량혈액려과치료대내독소유도적농독증휴극유저혈액동역학지표、혈장중염증개질수평급양대사지표적영향.방법 18두유저이용수궤수자표진행완전수궤화분조,분위대조조、혈액려과조(CVVH조)、고용량혈액려과조(HVHF조),매조6두.응용대장간균(O111∶ B4)내독소정맥주사유도휴극모형산생.우동물기출상태(B0h)、성모(0 h)、성모후2h(2h)、성모후4 h(4 h)、성모후6 h(6 h)분별기록심솔、평균동맥압、심수출량、외주혈관조력지수、흉내혈용량、혈장염증개질(IL-6、IL-10、TNF-α)급양대사지표.결과 혈액려과치료량조동물적혈액동역학득도일정역전；기중HVHF조혈액동역학개선교CVVH조경현저,4 h[(82±17) mmHg](1 mm Hg =0.133 kPa)、6 h[(80± 12) mm Hg]평균동맥압고우CVVH조[4 h(67±12) mm Hg；6 h(69±14) mm Hg] (P＜ 0.05),4 h[(1736±163) dyne·s·cm-5/m2]、6 h[(1786±171) dyne· s·cm-5/m2]외주혈관조력지수고우CVVH조[4 h(1159±99) dyne· s· cm-5/m2;6h(1196±184)dyne·s· cm-5/m2](P＜0.05);혈장각염증개질수평치료량조저우대조조,차6h시TNF-α[(56±9) pg/ml]급IL-6[(175 ±37) pg/ml]수평HVHF조저우CVVH조[TNF-α(67±13) pg/ml；IL-6(281 ±51) pg/ml] (P＜0.05)；양대사지표HVHF조양섭취솔재4 h(44％±3％)、6 h(43％±5％)고우CVVH조[4 h(33％±4％)；6 h(31％±3％)](P＜0.05).결론 조기고용량혈액려과교상규제량유조우강저농독증휴극유저모형적혈장염증개질수평,동시개선혈류동역학,병능개선양대사.
Objective To observe the effects of hemofiltration at early stage of septic shock with different ultrafiltration doses,including hemodynamics,oxygen metabolism,inflammatory mediator in piglet models,and to evaluate the therapeutic effects of HVHF.Method The 18 healthy young piglets (Shanghai species) were divided randomly into three groups:control group (n =6),conventional volume hemofiltration (CVVH) group [n =6,ultrafiltration volume =30 ml/(kg · h)] and high volume hemofiltration (HVHF) group [n =6,ultrafiltration volume =50 ml/(kg · h)],the animal model of septic shock was established by injection of lipopolysaccharide (LPS) (150 μg/kg) O111∶ B4.During the experiment,the following observations were carried out for all groups:1) Changes of hemodynamics [heart rate (HR),mean arterial pressure (MABP),cardiac output (CO),systemic vascular resistance index (SVRI),intrathoracic blood volume (ITBV)] and oxygen metabolism [oxygen delivery (DO2),oxygen consumption (VO2),oxygen extraction rate (O2ER)] at the time of B0h,0 h,2 h,4 h and 6 h.2) changes of TNF-α,IL-6,IL-10 in plasma at different time points (B0h,0 h,2 h,4 h,6 h).Result Significant difference in circulatory parameters,inflammatory mediators in plasma were found at B0h and 0 h among three groups; the CO in two treatment groups were higher than that in control group at 4 h,6 h after model establishment (P ＜ 0.05),and SVRI in HVHF groups were higher than that in other two groups at 4 h,6 h after model was established (P＜0.05).The MABP in HVHF group [4 h (82 ± 17) mm Hg,6 h (80 ± 12) mm Hg] (1 mm Hg =0.133 kPa) were higher than that in CVVH group at 4 h [(67 ± 12) mm Hg],6 h[(69 ± 14) mm Hg]after model was established (P ＜ 0.05).The levels of IL-6,IL-10,TNF-α in two treatment groups were lower than that in control group at 4 h and 6 h after model was established (P ＜ 0.05),and the IL-6[(281 ±51) pg/ml],TNF-α[(67 ± 13) pg/ml] level in HVHF group was lower than that in CVVH group [IL-6 (281 ± 51) pg/ml,TNF-α (67 ± 13) pg/ml] at 6 h (P ＜ 0.05).The DO2 and VO2 in two treatment groups were higher than that in control group at 4 h,6 h (P ＜ 0.05),the O2 ER in HVHF group were higher than that in CVVH group at4 h (44％ ±3％ vs.33％ ±4％),6 h (43％ ±5％ vs.31％ ±3％,P＜0.05).Conclusion High volume hemofiltration (HVHF) at early stage of septic shock piglet models was more effective in improving hemodynamics,oxygen metabolism than conventional CVVH.And HVHF eliminated blood inflammatory mediators more effectively than conventional CVVH.
