血液滤过用于亚低温治疗脑水肿的可行性观察  

Feasibility of hemofiltration used for mild hypothermia on cerebral edema

作　　者：黄东健[1] 徐如祥[2] 瞿文军[2] 

机构地区：[1]广州医学院附属广州市第二人民医院中心ICU,广东省广州市510150 [2]解放军第一军医大学珠江医院神经外科,广东省广州市510515

出　　处：《中国临床康复》2004年第25期5307-5309,共3页Chinese Journal of Clinical Rehabilitation

基　　金：广东省医学科研立项资助课题(A2002589)~~

摘　　要：目的:探索血液滤过用于创伤性脑水肿的亚低温治疗可行性和方法,血液滤过方法与传统亚低温疗法的降温效果差异;以及血液滤过对脑水肿治疗的作用机制。方法:12只健康犬随机分为2组:血液滤过组(A组,6只),传统降温组(B组,6只)。采用改进的Feeney法自由落体致犬脑损伤,均用机械通气辅助呼吸,伤后6h,A组在采用血液滤过体外循环降温,血流量为90～100mL,置换液为500～800mL/h;B组采用冰敷头部及腹部降温。持续监测肛温、生命体征,每2h检测血气分析,乳酸和细胞因子;伤后24h动物处死做脑组织水含量和组织学检查。结果:A组犬肛温可在15～18min后下降并维持在29～32℃;A组在开始时平均动脉压低于B组外,电解质和酸碱平衡,氧分压(PO2)显著优于B组;在治疗过程中,A组的外周血乳酸、肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6、白细胞介素-8水平显著低于B组(P<0.05～0.01),A组脑组织含水量(77.23±0.68)%也明显低于B组(79.32±0.52)%,差异有显著性意义(P<0.05)。结论:血液滤过用于脑损伤后的亚低温治疗,安全可行,其降温快速,体温容易控制;另外,高容量血液滤过能较好地调节内环境、清除体内细胞因子和乳酸等炎症递质,这对保护脑组织,减少继发性脑水肿有益。AIM:To explore the feasibility and method of hemofiltration in treatment of cerebral edema with mild hypothermia following head injury, to study the difference of reducing the temperature between hemofiltration and traditional method,and to analyze the action mechanism of hemofiltration for treating cerebral edema. METHODS:Twelve healthy dogs were randomly assigned into two groups: hemofiltration group(group A,n=6) and traditional reducing temperature group(group B,n=6).By mean of the improved Feeney method,dog models of head injury were established,and assisted respiration was performed by using mechanical ventilation.Six hours after injury,hemofiltration was used for reducing temperature through extracorporeal circulation in group A,the blood flow was about 90-100 mL per hour and the infusion rate of replacement fluid was about 500-800 mL per hour.Ice compress on head and abdominal part was performed in group B to reduce temperature.During the treatment,anus-temperature and vital signs were monitored continuously,the blood gas analysis,lactic acid and cytokine in plasma were measured every 2 hours.The brain water content and pathological examination were observed 24 hours after injury when the animals were killed. RESULTS:Anus-temperature of dogs in group A began to decrease after 15-18 minutes and maintained at 29-32 ℃.At the beginning, the mean arterial pressure,electrolure,acid-base balance and partial pressure of oxygen(PO2)in group A were all significantly higher than those in group B.During the treatment,the peripheral blood lactic acid,tumor necrosis factor-alpha(TNF-α),interleukin -1beta(IL-1β),IL-6 and IL-8 in group A were significantly lower than those in group B(P< 0.05-0.01).The brain water content in group A [(77.23±0.68)%] was obviously lower than that in group B[(79.32±0.52)%](P< 0.05).CONCLUSION:Hemofiltration can be used in the treatment of mild hypothermia after severe cerebral damage,by which the temperature is reduced speedily and easily to control,enhanced clearance of cytokines,lacti

关 键 词：血液滤过 亚低温治疗 脑水肿 肿瘤坏死因子-α 白细胞介素-1Β 白细胞介素-6 白细胞介素-8 

分 类 号：R742.7[医药卫生—神经病学与精神病学]