摘要
目的探讨持续血液滤过（CVVH）对甲型H1N1流感呼吸衰竭患者炎性因子、免疫稳态及血流动力学治疗的影响。方法通过对人选的10例甲型H1N1流感呼吸衰竭患者在常规治疗的基础上联合应用CVVH治疗，分别观察治疗前及治疗后24h、48h、72h、120h的血清炎性介质[肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、IL-8、IL-10]水平、免疫指标（CD3^＋、CD4^＋、CD4^＋／CD8^＋和HLA-DR／CD14^＋）、血流动力学指标及血管外肺水[心率（HR）、平均肺动脉压（mPAP）、外周循环阻力（SVR）、肺循环阻力（PVR）、心排量（CO）、胸腔液体容积（TFC）]，氧代谢指标[氧输送（DO2）、氧摄取率（ERO2）、氧摄取（V02）]以及APACHEII评分。结果与CVVH治疗前相比，治疗后24h、48h、72h、120h血液中的TNF-α、IL-6、IL-8均明显下降（P〈0．05）；免疫指标CD3^＋、CD4^＋、CD4^＋／CD8^＋和HLA—DR／CD14^＋在48h后各组内明显改善（P〈0．05）；CVVH对甲流呼吸衰竭患者的血流动力学有良好影响，48h后HR、TFC和72h的SVR、PVR均明显下降，CO、PAwP及mPAP在120h后逐渐趋向稳定，与CVVH治疗前比较有显著性差异（P〈0．05）；TFC与治疗前相比，48h后逐渐回落，有统计学差异（P〈0．05）；氧代谢观察CVVH前DO2、ERO2、VO2均明显增高，同时伴有PaO2的下降，CVVH72h后D02、ERO2、VO2逐渐稳定，同时伴有PaO2的上升，同时APACHEⅡ评分72h后也降低（P〈0．05）。结论CVVH可以清除甲流呼吸衰竭患者部分炎性因子，明显改善患者氧代谢，清除血管外肺水，平衡免疫稳态，改善呼吸功能，提高抢救成功率。
Objective To study the effects of continuous hemofiltration （CVVH） on inflammatory factor, immune steady-state and hemodynamic in influenza H1N1 flu respiratory failure patients. Methods Based on routine treatment, ten cases of flu patients with respiratory failure receired CVVH treatment. Before CVVH intervention and after intervention 24 h, 48 h, 72 h, 120 h, serum inflammatory mediators [-tumor necrosis factor-α （TNF-α）,interleukin-6 （IL-6）, IL-8, IL-10], immune index （CD3＋ ,CD4＋, CD4＋/CD8＋ and HLA-DR/CD14＋）, hemodynamic parameters and outside blood-vessel lung water （HR, mPAP, SVR, PVR, CO, TFC）, oxygen metabolic indexes （DO2, ERO2, VO2）, and APACHEII score were observed. Results TNF-α,IL-6,IL-8 declined obviously after CVVH for 24 h,48 h,72 h,120 h （ P 〈 0.05）. CD3＋ , CD4＋ , CD4＋/CD8＋ and HLA-DR/CD14＋ improved obviously after 48 h （ P d0.05 ）. CVVH improved blood cycle obviously for influenza H1N1 flu respiratory failure patients. HR and TFC decreased after CVVH for 48 h, SVR and PVR declined after CVVH for 72 h, and CO, PAWP and mPAP gradually stabilized after CVVH for 120 h. The changes of these parameters were statistically significant compared with those before CVVH （ P 〈0.05）. TFC reduced after CVVH for 48 h compared with before CVVH （ P 〈 0.05）. Before CVVH, DOe , ERO2, and VO2 increased, and oxygen partial pressure in pulmonary artery （PaO2） decreased. After CVVH for 72 h,DO2 ,ERO2 ,and VO2 gradually stabilized in association with the increases of oxygenation index and PaO2 and the decrease of APACHE Ⅱ scores （ P〈0.05）. Conclusions CVVH can remove a part of inflammatory factor, significantly improve oxygen metabolism, clear water, balance outside respiratory function and the rescue success for H1N1 blood-vessel lung immune steady-state, improve flu respiratory failure patients.
出处
《国际呼吸杂志》
2011年第24期1852-1856,共5页
International Journal of Respiration
基金
2009年兰州大学中央高校基本科研费自由探索项目（面上项目）（1zujhky-2009-100）
关键词
持续血液滤过
甲型H1N1流感
呼吸衰竭
氧代谢
免疫调节
Continuous hemofiltration
Influenza H1N1 influenza
Respiratory failure
Oxygenmetabolism
Immune regulation
