CAJ | 학술논문

目的对严重脓毒症患儿常规治疗基础上行连续性静脉-静脉血液滤过(continuous venous-venous hemofiltration,CVVH)治疗,通过监测不同时刻降钙素原(procalcitonin,PCT)、白细胞介素(interleukin,IL)-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α、IL-10等因子浓度的变化,探讨血液净化对严重脓毒症患儿炎性反应的疗效及最佳治疗时间.方法选取符合诊断标准的严重脓毒症患儿20例,在常规治疗基础上行CVVH治疗48 h.选取CVVH治疗0h、6h、12h、24h、48 h及CVVH治疗停止后12h6个时间点,分别检测外周静脉血清PCT、TNF-α、IL-6、IL-10的浓度.结果经CVVH治疗后各时间点,PCT浓度呈逐渐下降趋势,与0h相比,差异均有统计学意义(P＜0.05).治疗6h内PCT降低幅度最大,由0h的(6.79±1.75) μg/L降至(4.46±1.42)μg/L,至12 h PCT浓度降至最低,为(3.51-±1.45) μg/L,24h后各时间点PCT浓度较前略有回升,但与治疗后12 h PCT浓度比较,差异无统计学意义(P＞0.05).CVVH治疗后,TNF-α、IL-6、IL-10浓度值随治疗时间延长逐步降低,各时刻浓度与0h比较差异均有统计学意义(P＜0.05).治疗停止后12 h TNF-α、IL-6、IL-10浓度略有回升,但与治疗48 h相比差异无统计学意义(P＞0.05).TNF-α、IL-6浓度在治疗24 h后各时间点差异无统计学意义(P＞0.05).IL-10浓度在治疗12 h之后各时间点差异无统计学意义(P＞0.05).结论 CVVH能有效清除严重脓毒症患儿体内的TNF-α、IL-6、IL-10等炎性因子,降低PCT水平.CVVH清除炎性介质最佳有效时间为24～48 h.
목적 대엄중농독증환인상규치료기출상행련속성정맥-정맥혈액려과(continuous venous-venous hemofiltration,CVVH)치료,통과감측불동시각강개소원(procalcitonin,PCT)、백세포개소(interleukin,IL)-6、종류배사인자(tumor necrosis factor,TNF)-α、IL-10등인자농도적변화,탐토혈액정화대엄중농독증환인염성반응적료효급최가치료시간.방법 선취부합진단표준적엄중농독증환인20례,재상규치료기출상행CVVH치료48 h.선취CVVH치료0h、6h、12h、24h、48 h급CVVH치료정지후12h6개시간점,분별검측외주정맥혈청PCT、TNF-α、IL-6、IL-10적농도.결과 경CVVH치료후각시간점,PCT농도정축점하강추세,여0h상비,차이균유통계학의의(P＜0.05).치료6h내PCT강저폭도최대,유0h적(6.79±1.75) μg/L강지(4.46±1.42)μg/L,지12 h PCT농도강지최저,위(3.51-±1.45) μg/L,24h후각시간점PCT농도교전략유회승,단여치료후12 h PCT농도비교,차이무통계학의의(P＞0.05).CVVH치료후,TNF-α、IL-6、IL-10농도치수치료시간연장축보강저,각시각농도여0h비교차이균유통계학의의(P＜0.05).치료정지후12 h TNF-α、IL-6、IL-10농도략유회승,단여치료48 h상비차이무통계학의의(P＞0.05).TNF-α、IL-6농도재치료24 h후각시간점차이무통계학의의(P＞0.05).IL-10농도재치료12 h지후각시간점차이무통계학의의(P＞0.05).결론 CVVH능유효청제엄중농독증환인체내적TNF-α、IL-6、IL-10등염성인자,강저PCT수평.CVVH청제염성개질최가유효시간위24～48 h.
Objective To evaluate the clinical efficacy and the optimal duration of continuous venous-venous hemofiltration(CVVH) for children with severe sepsis through monitoring the change of the concentration of procalcitonin (PCT),interleukin (IL)-6,tumor necrosis factor (TNF)-α and IL-10 in different moment.Methods Twenty patients with severe sepsis were selected according to the diagnostic criteria.The concentrations of serum PCT,TNF-α,IL-6,IL-10 at 0 h,6 h,12 h,24 h,48 h after the CVVH were determined and compared.Results At every time point after CVVH,the levels of PCT showed a decreasing tendency,with significant differences compared with 0 h.The extent of PCT reduction reached a maximum within the first 6 hours,from (6.79 ± 1.75) μg/L at 0 h to (4.46 ± 1.42) μg/L at 6 h.The PCT concentration fell to a minimum at 12 h after CVVH[(3.51 ± 1.45) μg/L].After 24 h of CVVH,the concentration of PCT was increased than before,but there was no statistically significant difference compared with 12 h.The concentrations of TNF-α,IL-6,IL-10 gradually decreased with the duration of CVVH treatment,the concentration at each time after treatment showed significant difference compared with 0 h (P ＜ 0.05).At 12 h after treatment cessation,concentrations of TNF-α,IL-6,IL-10 increased slightly,but without significant difference compared to 48 h (P ＞ 0.05).The concentrations of TNF-α,IL-6 showed no differences after 24 h (P ＞ 0.05),and IL-10 concentration showed no difference after 12 h of CVVH (P ＞ 0.05).Conclusion The CVVH can effectively remove the TNF-α,IL-6,IL-10 and other inflammatory factors of children with severe sepsis,reduce the level of PCT.The best available time of CVVH is 24 ～ 48 h after symptom onset.