持续高流量血液滤过对重症急性胰腺炎猪炎症反应的影响  

Effects of high-volume continuous hemofiltration on inflammatory reaction in experimental porcine pancreatitis in pig

作　　者：燕晓雯[1] 李维勤[1] 王浩[1] 张震环[1] 黎介寿[1] 李宁[1] 

机构地区：[1]南京大学医学院临床医院(南京军区南京总医院)普通外科研究所ICU,210002

出　　处：《中国危重病急救医学》2006年第3期165-168,共4页Chinese Critical Care Medicine

基　　金：江苏省社会发展基金资助项目(BS2000051)

摘　　要：目的探讨高流量持续血液滤过对重症急性胰腺炎(SAP)时炎症反应的影响。方法采用胰管内高压力注射牛磺胆酸钠和胰蛋白酶的方法诱导猪SAP模型。将SAP模型动物随机分为3组,每组8只:对照组只行常规支持治疗;低流量持续性静静脉血液滤过(CVVH)组除常规支持治疗外,模型诱导成功后立即行低流量(20 m l.kg-1.h-1)CVVH;高流量CVVH组模型诱导成功后立即行高流量(100 m l.k-g 1.-h 1)CVVH以及常规支持治疗。于SAP诱导前和诱导成功后6、12、24和36 h间断测定血浆肿瘤坏死因子α(TNFα)、白细胞介素6(IL 6)和IL 10含量,于SAP诱导后6、12和24 h测定外周血中单核细胞核转录因子κB(NFκB)活性。结果对照组平均生存时间为41 h,低流量CVVH组平均生存时间为50 h,高流量CVVH组平均生存时间为65 h。早期行CVVH治疗动物生存时间均显著高于对照组(P<0.05和P<0.01),高流量CVVH组的生存时间明显高于低流量CVVH组(P<0.05)。CVVH治疗后TNFα、IL 6和IL 10均较对照组显著降低,高流量CVVH组的TNFα、IL 6和IL 10含量均显著低于低流量CVVH组。两个CVVH组动物的外周血单核细胞NFκB活性在6、12和24 h均显著低于对照组,高流量CVVH组更低。结论早期CVVH能改善SAP猪过度的炎症反应,明显延长生存时间,改善预后,而且高流量CVVH的效果明显优于低流量CVVH。Objective To investigate the effect of high- volume continuous hemofiltration on the inflammatory reaction in experimental severe acute pancreatitis （SAP）. Methods SAP was reproduced in pigs by intraductal injection of sodium taurocholate and trypsin, and they were randomly divided into three groups. Control group consisted of animals with SAP running its spontaneous course. Low-volume continuous venovenous hemofiltration （CVVH） group animals received a low volume （20ml·kg^-1·h^-1） CVVH, and high -volume CVVH group animals received a high volume （100 ml·kg^-1·h^-1） CVVH both started at the onset of SAP. Vital signs were monitored. The serum concentrations of tumor necrosis factor-α （TNF -α）, interleukin -6 （IL -6）, IL -10, and activated nuclear factor-kB （NF- kB） levels of peripheral blood mononuclear cell were determined at 0, 6, 12, 24, and 36 hours after the onset of SAP. Results The median survival time of control, low - volume and high - volume CVVH groups was respectively 41 hours, 50 hours and 65 hours. Survival time of the latter two groups was significantly higher than that in control group （P〈0. 05 and P〈0. 01）, and the survival time of animals in high - volume CVVH group was significantly higher than low - volume CVVH （P〈0.05）. In the high - volume CVVH group, plasma contents of TNF -α, IL - 6 and IL - 10 were lower significantly than in the low -volume CVVH and control groups from the beginning to the end of the experiment. In high-volume CVVH group, the expressions of NF -kB activation at 6, 12 and 24 hours were lower than those in the control and low -volume CVVH groups respectively. Conclusion Early CVVH can blunt the excessive inflammatory reaction in experiment porcine panereatitis in pigs, obviously prolong survival time, and improve prognosis. High - volume CVVH is significantly efficacious compared with low - volume CVVH in these respects.

关 键 词：持续高流量血液滤过 胰腺炎 急性 重症 细胞因子 核转录因子-KB 猪 

分 类 号：R657.51[医药卫生—外科学] R364.5[医药卫生—临床医学]