不同血液净化方式对伴急性肾衰多器官功能障碍疗效研究.docVIP

不同血液净化方式对伴急性肾衰多器官功能障碍疗效研究 　　 [摘要] 目的:观察血液灌流(HP)联合持续性静脉-静脉血液滤过(CVVH)治疗伴急性肾功能衰竭(ARF)的多器官功能障碍综合征(MODS)患者的临床疗效,并探讨其机制。方法：将40例伴ARF的MODS患者随机分为两组,一组单纯以CVVH治疗,另一组以HP+CVVH治疗,比较两组治疗前后APACHEⅡ评分改善、尿素氮、肌酐和TNF-α及IL-6变化情况。结果：两组治疗后,患者临床状况改善；APACHE Ⅱ评分均下降,联合治疗组下降更明显；尿素氮和肌酐均下降,两组之间无差别；血清TNF-α及IL-6均降低,但联合治疗组明显优于单纯治疗组(P 　　［关键词］ 持续血液净化； 血液灌流; 急性肾功能衰竭； 多器官功能障碍综合征 　　［中图分类号］ R459.5; R692.5 ［文献标识码］ A ［文章编号］ 1671-7256(2011)02-0178-03 　　doi:10.3969/j.issn.1671-7256.2011．02.017 　　Observation on different blood purification modes for multiple organ 　　dysfunction syndrome patients associated with acute renal failure 　　LAO Zhi-gang, XIONG Xiao-ling, WU Hao, WANG Su-ning, 　　DAI Liang-cheng, RU Huang-yao 　　(ICU, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, China) 　　［Abstract］ Objective: To investigate the efficacy of hemoperfusion(HP) with continuous blood purification(CBP) on patients suffered from multiple organs failure with acute renal failure and its mechanism. Methods: 40 patients were divided into two groups randomly, one group received continuous blood purification treatment only, and the other group was received HP with CBP treatment. Comparison of the change of APACHEⅡscore and the level of BUN, Cr, TNF-α and IL-6 before and after treatment was made. Results: After treatment, the clinical symptoms of patients in both two groups were improved, the APACHEⅡscore reduced, as well as the level of BUN and Cr. But there was no significant difference of BUN and Cr in two groups. Furthermore, the levels of TNF-α and IL-6 also declined. The efficacy in the combination treatment group was better than the CBP group(P 　　3 讨 论 　　MODS是全身炎症反应综合征(SIRS)进行性加重的严重结果,机体炎症反应失控导致的免疫紊乱是MODS发生的根本原因。当机体受到严重打击后,细菌/毒素或组织损伤将刺激炎症细胞产生大量炎症介质,它们可以进一步刺激和激活巨噬细胞、粒细胞、淋巴细胞及内皮细胞释放更大量的炎性介质,诱发失控的炎症反应,形成瀑布效应。在炎症反应中,TNF-α、白细胞介素-1(IL-1)、IL-6和白细胞介素-8(IL-8)是目前被公认能较好地反映SIRS的细胞因子［3-4］。TNF-α水平在严重MODS时与预后相关联［5］,IL-6、IL-8具有强烈的中性粒细胞趋化作用和激活作用,引起组织细胞的损伤,炎症的程度也与其局部浓度有关［6］。