不同超滤膜对重症脓毒症患者外周血细胞因子影响.docVIP

不同超滤膜对重症脓毒症患者外周血细胞因子影响 　【摘要】 目的 观察不同超滤膜对外周血细胞因子水平的动态变化,了解不同的膜材料对细胞因子的清除效果及作用维持时间。方法 20例重症脓毒症患者随机分为两组，治疗组(10例)，应用AN69膜，对照组(10例)，应用PS膜，观察在连续性静脉-静脉血液滤过（CVVH）过程中0、2、4、6、8、10、12h的肿瘤坏死因子-α(TNF-α)、白介素1β(IL-1β)、白介素-6(IL-6)和白介素-8(IL-8)的水平。 结果 各种细胞因子水平在CVVH后2h即下降，TNF-α于治疗4h降至最低，4、6h治疗组较对照组下降更明显(Plt;0.05)；IL-1β、IL-6、IL-8 6h降至最低，治疗组较对照组下降更明显(Plt;0.05)；各种细胞因子水平于治疗12h均明显升高并接近治疗前水平。 结论 AN69膜及PS膜对细胞因子均有清除作用，但以AN69膜的滤器清除效果更强。对于重症脓毒症患者两者的滤器作用维持时间约为10h。 【关键词】 超滤膜 连续性静脉-静脉血液滤过 重症脓毒症 细胞因子 　　【Abstract】 Objective To observe the effect of different ultrafiltration membrane on dynamic change of peripheral blood cytokine, to study the removal effect and lasting time of different membrane material. Methods 20 sepsis patients were randomly divided into therapy group (10 patients) and control group (10 patients). Therapy group were treated with AN69 membrane and control group were treated with PS membrane . Levels of TNF-α, IL-1β, IL-6, IL-8 at 0h, 2h, 4h, 6h, 8h, 10h, 12h in the process of continuous venovenous hemofiltration (CVVH) were tested. Results Levels of all the cytokines decreased at 2h. The level of TNF-α decreased to the lowest at 4h, and it decreased more significantly in therapy group than in control group (Plt;0.05) at 4h and 6h. The levels of IL-1β, IL-6, IL-8 decreased to the lowest at 6h, and they decreased more significantly in therapy group than in control group(Plt;0.05) at that time. Levels of all cytokines increased at 12h and increased to the level before therapy. Conclusions AN69 membrane and PS membrane both have removal effects on cytokines, but the removal effect of AN69 membrane is better. Functions of both of them lasts about 10 hours in patients with severe sepsis. 　　【Key words】 Ultrafiltration membrane Continuous venovenous hemofiltration (CVVH) Severe sepsis Cytokine 　　连续性血液净化（CBP）是近年来得到迅速发展的新的血液净化技术，由于治疗的连续性和血液动力学的稳定性，特别是能够有效地吸附和清除循环血液中的细胞因子等多种炎症介质，在治疗各种危重症疾病如急性胰腺炎、烧伤、创伤、全身炎症反应综合征及脓毒症(SIRS/Sepsis)过程中取得了较明显的疗效［１，２］。脓毒症在临床上较为常见，是指由感染引起的全身炎症反应综合征，当伴有器官功能障碍时则称为重