摘要
目的探讨连续性血液净化(CBP)治疗对急性呼吸窘迫综合征(ARDS)患者肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)水平及预后的影响。方法选取2014年2月至2016年2月兰州市第一人民医院收治的ARDS的患者32例。16例行CBP治疗,为血液净化组;16例未予CBP治疗,为对照组。CBP组采用连续性静脉-静脉血液透析滤过模式治疗3～5d,对照组采用常规治疗。监测2组患者治疗12、24、36、48、72h后外周血清TNF-α、IL-1水平,治疗2、6、12、24、36、48、72h后血氧分压、二氧化碳分压、氧合指数及2组患者的病死率。结果治疗36、48、72 h后血液净化组TNFα、IL-1水平明显低于对照组,差异均有统计学意义[TNF-α:(36.42±0.41)ng/L比(49.54±0.47)ng/L、(32.79±0.32)ng/L比(51.36±0.24)ng/L、(29.47±0.58)ng/L比(56.68±0.21)ng/L;IL-1:(28±6)ng/L比(48±15)ng/L、(25±4)ng/L比(54±10)ng/L、(23±3)ng/L比(80±14)ng/L](均P<0.05)。治疗24、36、48、72 h后血液净化组血氧分压、氧合指数明显高于对照组,二氧化碳分压明显低于对照组,差异均有统计学意义(均P<0.05)。血液净化组病死率低于对照组,差异有统计学意义[18.8%(3/16)比43.8%(7/16)](P<0.05)。结论 CBP治疗能明显抑制ARDS患者TNF-α和IL-1的表达,改善患者氧合状态,降低患者病死率。
Objective To investigate the effect of continuous blood purification（CBP） on tumor necrosis factor（TNF）-α, interleukin（IL）-1 and prognosis in patients with acute respiratory distress syndrome（ARDS）. Methods Thirty-two ARDS patients were enrolled from February 2014 to February 2016 in the First People′s Hospital of Lanzhou City; 16 of them had CBP therapy for 3-5 d（CBP group） and 16 patients had routine treatments（control group）. Serum levels of TNF-α and IL-1 were detected 12, 24, 36, 48, 72 h after treatment. Partial pressure of oxygen, partial pressure of carbon dioxide and oxygenation index were measured 2, 6, 12, 24, 36, 48, 72 h after treatment. The fatality rate was analyzed. Results Levels of TNF-α and IL-1 36, 48, 72 h after treatment in CBP group were significantly lower than those in control group［TNF-α： （36.42±0.41）ng/L vs （49.54±0.47）ng/L, （32.79±0.32）ng/L vs（51.36±0.24）ng/L, （29.47±0.58）ng/L vs （56.68±0.21）ng/L; IL-1： （28±6）ng/L vs （48±15）ng/L,（25±4）ng/L vs （54±10）ng/L, （23±3）ng/L vs （80±14）ng/L］（P＜0.05）. Partial pressure of oxygen and oxygenation index 24, 36, 48, 72 h after treatment in CBP group were significantly higher, and partial pressure of carbon dioxide was significantly lower than those in control group（P〈0.05）. The fatality rate in CBP group was significantly lower than that in control group［18.8%（3/16） vs 43.8%（7/16）］（P＜0.05）. Conclusion CBP can significantly inhibit expressions of TNF-α and IL-1, improve oxygenation status and reduce the fatality in patients with ARDS.
作者
陈玮
Chen Wei(Intensive Care Unit, the First People＇s Hospital of Lanzhou City, Lanzhou 730050, Chin)
出处
《中国医药》
2018年第2期216-219,共4页
China Medicine
