【摘要】 目的探讨连续性高容量血液滤过(HVHF)和连续性静脉-静脉滤过透析(CVVHDF)两种模式对脓毒症的治疗效果。方法 51例脓毒症患者随机分为两组,HVHF组27例,CVVHDF组24例。HVHF组置换液量4L/h;CVVHDF组置换液量2L/h,透析液量2L/h。于治疗前和治疗后24小时测定血清白细胞介素(IL)-6浓度,治疗后测定超滤液中IL-6浓度。同时观察两组患者治疗前后体温、心率(HR)、平均动脉压(MAP)、氧合指数(PaO2/FiO2)、尿素氮(BUN)、肌酐(Cr)的变化。结果治疗后HVHF组及CVVHDF组血清IL-6浓度较治疗前均明显降低,HVHF组(98.97±38.45)ng/L vs(161.84±50.03)ng/L(P<0.01);CVVHDF组(125.53±41.44)ng/L vs(143.77±41.28)ng/L(P<0.05),HVHF组血清IL-6浓度降低较CVVHDF组更显著(P<0.01);两组超滤液中均检测到IL-6。两组治疗后较治疗前体温、BUN及SCr均明显下降(P<0.01),但组间比较差异无统计学意义。两组治疗后较治疗前PaO2/FiO2明显升高,HVHF组:253.67±55.92vs 173.52±44.59(P<0.01);CVVHDF组:208.17±42.37vs 178.38±36.25(P<0.01),HVHF组较CVVHDF组氧合改善更明显(P<0.01)。两组治疗前后、两组之间HR、MAP水平差异无统计学意义。结论 HVHF、CVVHDF两种模式均能清除炎性介质,HVHF清除效果优于CVVHDF。HVHF较CVVHDF更能降低机体基础代谢率,增加机体组织的氧供,改善脓毒症患者脏器功能的指标。更多还原

【Abstract】 Objective To investigate the therapy effect of continuous high volume hemofiltration(HVHF) and continuous veno-venous hemodiafiltration(CVVHDF) on sepsis. Methods 51 patients suffering from sepsis were randomly divided into two groups:HVHF group(n=27) and CVVHDF group(n=24).The amount of replacement fluid in HVHF group was 4 L/h,and in CVVHDF group,the amount of replacement fluid was 2 L/h,and the amount of dialysate was 2 L/h.The levels of IL-6 in both serum and ultrafiltrate were measured before treatment and after 24-hour treatment.Meanwhile,the variance of the temperature,heart rate(HR),mean arterial pressure(MAP),oxygenation index(PaO2/FiO2),urea nitrogen(BUN),creatinine(Cr) before and after treatment in two groups were observed. Results In two groups,the levels of serum IL-6 after treatment were much lower than those before treatment,HVHF group(98.97±38.45) ng/L vs(161.84±50.03) ng/L(P<0.01);CVVHDF group(125.53±41.44) ng/L vs(143.77±41.28) ng/L(P<0.05).The level of serum IL-6 after treatment in HVHF group reduced more obviously than that in CVVHDF group(P<0.05).IL-6 could be detected in the ultrafiltrate of both HVHF group and CVVHDF group.In two groups,the body temperature after treatment was much lower than that before treatment(P<0.01).The levels of BUN and SCr after 24-hour treatment were much lower compared to those before treatment(P<0.01).While the levels of body temperature and BUN and SCr differences in two groups were not statistically significant.The PaO2/FiO2 after treatment was much higher than that before treatment,HVHF group 253.67±55.92 vs 173.52±44.59(P<0.01);CVVHDF group 208.17±42.37 vs 178.38±36.25(P<0.01).The PaO2/FiO2 after treatment in HVHF group improved more obviously than that in CVVHDF group(P<0.01).The HR and MAP differences before and after treatment or between two groups were not statistically significant. Conclusion HVHF and CVVHDF-the two patterns of continuous blood purification can both remove inflammatory mediators,while the effect of HVHF is better than that of CVVHDF.Compared to CVVHDF,HVHF can reduce body’s basal metabolic rate,increase the oxygen supply of tissues and improve the indicators of organ function on sepsis’ patients more obviously.更多还原