血液滤过治疗严重烧伤脓毒症伴发的高钠血症  

The effect of hemofiltration on sepsis and hypernatremia in severely burned patients

作　　者：申传安[1] 柴家科[1] 姚咏明[1] 李冀军[1] 盛志勇[1] 杨红明[1] 高建川[1] 李利根[1] 贺立新[1] 郝岱峰[1] 贾晓明[1] 

机构地区：[1]解放军第304医院全军烧伤研究所临床部,北京100037

出　　处：《感染．炎症．修复》2002年第4期226-228,共3页Infection Inflammation Repair

基　　金：国家自然科学基金资助项目(No.39970716);全军"十五"医药卫生重点课题基金(N0.01Z095)

摘　　要：目的:探讨血液滤过对严重烧伤脓毒症合并高钠血症病人的疗效。方法:应用持续静脉—静脉血液滤过方法治疗8例严重烧伤脓毒症合并高钠血症的病人。观察病情、外周血电解质、血流动力学、氧摄取率变化;检测血滤开始时、血滤结束时血浆内炎性介质(IL-1β、IL-6、IL-8和 TNF-α)浓度变化以及滤液中上述炎性介质的含量,计算跨膜清除率。结果:病人经血液滤过治疗后,临床症状好转,血流动力学趋于稳定,血钠浓度恢复至生理水平。动脉血氧饱和度、氧分压以及氧摄取率均明显升高,差异有显著意义(P<0.01)。血滤结束时血浆内IL-1β、IL-6、IL-8和 TNF-α的浓度较血滤前明显下降,差异有显著意义(P<0.01)。超滤液中也检测到上述4种细胞因子。随血滤时间延长,IL-1β、IL-6跨膜清除率明显下降,差异有显著意义(P<0.01),IL-8和 TNF-α跨膜清除率无明显变化,差异无显著意义(P>0.05)。结论:血液滤过能在较短的时间内平稳而有效降低病人外周血钠离子浓度,并能部分清除体内 IL-1β、IL-6、IL-8和 TNF-α等炎性介质,平衡机体炎性反应,稳定血流动力学、改善病情,对治疗烧伤脓毒症伴发的高钠血症,降低其高病死率有积极作用。Objective:To observe the effects of hemofiltration on the treatment of severely burned patients with sepsis and hypernatremia.Methods;Eight burned patients with sepsis and hypernatremia were treated with veno- venous hemofiltration.The patients' conditions,hemodynamics,plasma concentrations of sodium and oxygen ex- traction ratio were observed.Plasma and ultrafiltrate concentrations of inflammatory mediators were measured at the onset and end of hemofiltration.Results;After venovenous hemofiltration,the patients' conditions were amel- iorated,hemodynamics tended to become stable,the plasma concentrations of sodium were restored to physiologi- cal range.The arterial oxygen saturation,partial pressure of oxygen and oxygen extraction ratio were all signifi- cantly increased after hemofiltration (P<0.01).The plasma concentrations of IL-1β,IL-6,TNF-α,and IL-8 were markedly decreased after hemofiltration,as compared with that at the onset of treatment.(P<0.01).In ul- trafiltrate,these cytokines were also detected.Transmembrane clearance rate of IL-1β and IL-6 decreased with the elapse of time (P<0.01).However,the change in clearance rate of TNF-α was not obvious (P>0.05).Conclu- sions;The results indicate that hemofiltration could not only significantly correct hypernatremia,but alsoremove inflammatory mediators from the blood,restore balance of the systemic inflammatory response,maintain the he- modynamics,and improve the patient's conditions,so that it offers positive effects on severely burned patients with sepsis.

关 键 词：高钠血症 烧伤脓毒症 血液滤过 细胞因子 

分 类 号：R64[医药卫生—外科学]