作　　者： (李小丽）; (刘鲁沂）; (初静）; (梁亚凤）; (李梅凤）; (田行瀚）; (王希锋）; (于清霞）; (刘佳）;

机构地区： 青岛大学附属烟台毓璜顶医院重症医学科,山东省烟台264000

出　　处： 《中华急诊医学杂志》 2017年第8期919-923,共5页

摘　　要： 目的：观察配对血浆吸附滤过（coupled plasma filtration adsorption，CPFA）治疗对重症脓毒症并发多器官功能障碍综合征（MODS）患者血浆部分细胞因子（TNF-α、IL-1β、IL-6）浓度、细胞免疫、血乳酸水平、血液有形成分、心率、呼吸频率、氧合指数、血流动力学及预后等方面的影响。方法：选择符合重症脓毒症并发MODS患者随机（随机数字法）分为三组：CVVH组，血液灌流＋CVVH（HP＋CVVH）组和CPFA组。 三组病人记录临床一般资料、ApacheⅡ评分、器官衰竭数目及上述相关指标。每天血液净化治疗前后采血，分离血浆标本-60℃冰箱冻存，分批检测标本TNF-α、IL-1β、IL-6浓度。结果：CPFA治疗血浆分离吸附2h后血浆TNF-α、IL-6、IL-1β浓度均较前下降，P〈0.01，继续CVVH治疗10h后血浆IL-6浓度较吸附后下降，P〈0.05，血浆TNF-α、IL-1β较吸附后下降有下降趋势，但P〉0.05，无统计学差异。HP＋CVVH治疗对血浆TNF-α、IL-6、IL-1β浓度的影响与CPFA治疗组相似，组间比较未见明显差异。CVVH组：CVVH治疗12h血浆TNF-α、IL-6、IL-β浓度均较治疗前下降，P〈0.05。对比三种血液净化方式HP＋CVVH、CPFA治疗对TNF-α、IL-6、IL-1β三种炎性介质的清除无明显差别，与CVVH治疗相比较，HP＋CVVH、CPFA治疗组患者血清IL-6浓度明显降低，P〈0.05，而TNF-α水平有降低趋势，但P＞0.05，而IL-1β水平三组治疗间未见明显差别。HP＋CVVH、CPFA、CVVH三组治疗的患者均观察到血乳酸、心率、呼吸频率、氧合指数等临床指标的明显改善，血管活性药物的用量明显减少，T淋巴细胞亚群的CD3＋、CD4＋、CD8＋、CD4＋/CD8＋ 比值与治疗前相比上升。CPFA、CVVH两种血液净化方式治疗前后红细胞、白细胞、血小板水平未见明显变化，两组相比无明显差别。HP＋CVVH治疗后血小板水平有下降趋势，统计学P＜0.05。 CPFA组与CVVH治疗组� Objective To investigate the effect of coupled plasma filtration adsorption （CPFA） on plasma cytokines： TNF-α、IL-1β、IL-6, cellular immunity, blood lactate acid concentration, heart rate, respiration rate, oxygenation index, hemodynamies, blood eeUs counts, and prognosis in patients withnmhiple organ dysfunction syndromes （MODS）. Methods This was a prospective, randomized clinical trial in 45 patients diagnosed as MODS. Patients were randomly assigned to hemopeffution with resin adsorption （HP） ＋ continuous venous-venous hemofihration （CVVH） group, CPFA group and CVVH group. The general clinical data, APACHE Ⅱ score, number of failure organ and previous mentioned biomarkers were documented. Blood samples were collected before and after blood filtration with any one of these procedures. The plasma samples were isolated and stored with frozen at -60 ℃. Data were statistically analyzed with SPSS 13.0 version software. Results In CPFA group, plasma cytokines, TNF-α、IL-1β、IL-6, decreased markedly after plasma adsorption for two hours （ P 〈 O. 01 ） ; and plasma concentrations of IL-6 were further descended after subsequent CVVH for 10 hours （P 〈 O. 05 ）. In HP ＋ CVVH group, plasma cytokines, TNF-α、IL-1β、IL-6, decreased markedly after HP （P 〈 0.0l ） , and plasma concentrations of IL-6 were further descended after subsequent CVVH for 10 hours （P 〈 0. 05 ）. In CVVH group, plasma cytokines, TNF-α、IL-1β、IL-6, decreased after CVVH for 12 hours （ P 〈 0.05 ）. Blood lactate acid concentration, heart rate, respiration rate, oxygenation index, T-lymphocytes subgroups （CD3 ＋ , CD4 ＋ , CD8 ＋ , CD4 ＋/CD8 ＋ ratio） , clinical symptoms were improved and dose of vasoactive agent was reduced in the patients of three groups without differences among them. The counts of red blood cells, white blood cells and platelets after CPFA and CVVH showed no significant changes. There was no significant difference in blood cell counts between CPFA and CVVH gr

关 键 词： 血液灌流树脂吸附 配对血浆吸附滤过 多器官功能障碍综合征 细胞因子