摘要
目的观察连续性血液透析滤过(CVVHDF)和高容量血液滤过(HVHF)对多器官功能障碍(MODS)犬器官功能和细胞因子白细胞介素-1(IL-1)、IL-4的影响,探讨两种治疗模式对MODS的治疗效果。方法 18只Beagle犬采用失血性休克+复苏再灌注+内毒素血症建立MODS模型,随机分为CVVHDF组(n=6)、HVHF组(n=6)和MODS组(n=6)。内毒素注射完毕后CVVHDF组、HVHF组接受相应血液净化治疗24 h。测定各时间点血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Scr)、尿素氮(BUN)、动脉血氧分压(Pa O2)及二氧化碳分压(Pa CO2),应用酶联免疫吸附测定法(ELISA)测定IL-1和IL-4浓度。结果血液净化治疗后血浆IL-1、IL-4浓度在各时间点均明显下降,差异有统计学意义(P<0.05或P<0.01)。与HVHF组相比,CVVHDF组IL-1、IL-4浓度在内毒素注射完后6 h明显升高,在内毒素注射完后24 h明显下降,差异有统计学意义(P<0.05)。血液净化治疗后动物各器官功能均得到改善。与HVHF组相比,CVVHDF组Pa O2值在注射内毒素后12 h明显升高,差异有统计学意义(P<0.05)。与HVHF组相比,CVVHDF组Scr、BUN在注射内毒素后15 h、24 h明显升高,差异有统计学意义(P<0.05或P<0.01)。与HVHF组相比,CVVHDF组ALT值在注射内毒素后15 h明显降低,差异有统计学意义(P<0.01);AST值在注射内毒素后6 h、12 h明显降低,差异有统计学意义(P<0.01)。结论 CVVHDF与HVHF均可以改善组织缺氧,减轻肝、肾、肺功能损伤。HVHF对炎症介质的清除更优于CVVHDF。
ObjectiveTo observe the effect of high volume hemofiltration (HVHF) and continuous veno-venoushemo dialysis filtration (CVVHDF) on the expression of major organs’ function and the concentration of IL-1, IL-4 in the blood during the treatment of multiple organ dysfunction syndrome (MODS). Compared the effects of the two blood purification.MethodsEighteen Beagle dogs were subject to hemorrhagic shock plus resuscitation and endotoxemia to establish MODS model, then they were randomly divided into three groups, CVVHDF group (n=6), HVHF group (n=6) and MODS group (n=6). After endotoxin injection completed, the CVVHDF group and the HVHF group received blood purification for 24 hours. Serum alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine (Scr), urea nitrogen (BUN), PaO2 and PaCO2 were routinely measured, then plasma interleukin-1 (IL-1) and IL-4 concentrations were measured by ELISA at different time points.ResultsAfter blood purification, the concentration of IL-1 and IL-4 were both significantly decreased (P<0.05 orP<0.01). Compared with HVHF group, the concentration of IL-1 and IL-4 were significantly decreased at 6 h and increased at 24 h in CVVHDF group (P<0.05). The function of organs were all improved after blood purification. Compared with HVHF group, the PaO2 was significantly increased at 12 h in CVVHDF group (P<0.05). Compared with HVHF group, the Scr and BUN were significantly increased at 15 h, 24 h in CVVHDF group (P<0.05 orP<0.01). Compared with HVHF group, the ALT was significantly decreased at 15 h and the AST was significantly decreased at 6 h, 12 h in CVVHDF group (P<0.01).ConclusionBoth CVVHDF and HVHF can improve tissue hypoxia, mitigate the injury of lung, liver and kidney. HVHF is better at clearance of inflammatory mediators than CVVHDF.
出处
《中华临床医师杂志（电子版）》
CAS
2015年第21期75-79,共5页
Chinese Journal of Clinicians(Electronic Edition)
基金
新世纪优秀人才支持计划(NCET-12-1077)
