炎性介质在高容量血液滤过治疗脓毒症并急性呼吸窘迫综合征中的变化及意义  

Roles and Significance of Inflammatory Mediators in Treatment of Sepsis Complicated Acute Respiratory Distress Syndrome with High Volume Hemofiltration

作　　者：张安兵[1] 江红[2] 

机构地区：[1]襄阳市中心医院风湿免疫科,湖北襄阳441021 [2]襄阳市中心医院妇产科,湖北襄阳441021

出　　处：《湖北医药学院学报》2011年第4期384-387,共4页Journal of Hubei University of Medicine

摘　　要：目的:探讨炎性介质在高容量血液滤过(HVHF)治疗脓毒症并发急性呼吸窘迫综合征(ARDS)中的水平变化及与肺氧合功能的关系。方法:采用HVHF法治疗28例脓毒症并发ARDS患者,观察患者治疗前及治疗后1、2、4、8、16 h的动脉血气及呼吸力学指数,并用放射免疫法同步检测炎性因子水平;记录治疗前及治疗16 h后的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。结果:与治疗前相比,治疗后IL-6、IL-10及TNF-α水平显著下降,PaO2/F iO2和Cst显著升高,PIP和Pp lat显著降低(P<0.05或P<0.01);治疗后16 h APACHEⅡ评分明显高于治疗前(P<0.01)。结论:HVHF可通过调节炎性介质水平,改善肺水肿、提高肺氧合能力从而改善ARDS症状。Objective To investigate the inflammatory mediators level changes in the treatment of sepsis complicated acute respiratory distress syndrome(ARDS) with high volume hemofiltration(HVHF),and to explore its relationship with lung oxygenation function.Methods Twenty-eight sepsis patients complicated with ARDS were treated with HVHF,the arterial blood gas and mechanics of breathing were monitored at the following time points,before treatment and 1,2,4,8,16 hours after treatment.Meanwhile,the levels of inflammatory mediators were determined with radioimmunoassay.The acute physiology and chronic health evaluation Ⅱ were recorded at before treatment and treated for 16 h,respectively.Results The serum levels of IL-6,IL-10,TNF-α were significantly decreased after treatment,meanwhile the indexes of oxygenation(PaO2/FiO2) and pulmonary compliance(Cst) were significantly increased,but PIP and Pplat were significantly decreased(P<0.05 or P<0.01).After treated for 16 hours,the APACHEⅡ scores was obviously increased than that before treatment(P<0.01).Conclusion The regulation of inflammatory mediator levels with HVHF could improve the status of pulmonary edema and compliance,thus improving ARDS.

关 键 词：高容量血液滤过 脓毒症 急性呼吸窘迫综合征 炎性介质 

分 类 号：R459.7[医药卫生—急诊医学]