持续性血液净化联合血液灌流对脓毒性休克患者单核细胞功能的影响  

Effects of continuous veno-venous hemofiltration combined with hemoperfusion on monocytes function in patients with septic shock

作　　者：张伟文[1] 罗建[1] 楼炳恒[1] 祝利华[1] 王丹琼[1] 王舜尧[1] 熊晓华[1] 苏丽芳[1] 柴滨[1] 

机构地区：[1]衢州市人民医院重症医学科,浙江衢州324000

出　　处：《全科医学临床与教育》2012年第6期606-610,共5页Clinical Education of General Practice

基　　金：浙江省卫生厅科技计划在研项目(项目编号2010KYB139)

摘　　要：目的观察持续性血液净化(CVVH)联合血液灌流(HP)对脓毒性休克患者单核细胞分泌功能的影响。方法将60例脓毒性休克患者随机分为治疗组和对照组。在内科常规治疗的基础上,治疗组采用CVVH联合HP,每日血液灌流一次;对照组采用CVVH。治疗时间均为3 d。运用酶联免疫吸附试验方法(ELLSA)方法检测两组患者治疗前、治疗后1 d、3 d的内毒素(LPS)及肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6的浓度。分离的单核细胞体外培养后予LPS刺激,运用ELLSA方法检测其分泌TNF-α和IL-6的浓度。同时分析两组多器官功能障碍综合征(MODS)发生率、28 d死亡率。结果与同组治疗前比较,两组患者治疗1 d后LPS及TNF-α、IL-1β、IL-6浓度均有下降趋势,但差异均无统计学意义(t分别=0.44、0.98、1.02、1.24;0.53、0.83、1.25、1.11,P均>0.05),单核细胞分泌TNF-α和IL-6功能均无改善,差异亦均无统计学意义(t分别=-1.26、-0.92、-1.32、-0.91,P均>0.05);与同组治疗前比较,治疗3 d后两组患者LPS及TNF-α、IL-1β、IL-6浓度均有明显下降,差异均有统计学意义(t分别=3.68、4.74、2.58、2.42;2.43、4.01、2.47、2.43,P均<0.05),治疗组较对照组改善明显,差异均有统计学意义(t分别=3.07、2.59、2.40、3.13,P<0.05);两组单核细胞分泌TNF-α、IL-1β、IL-6功能较同组治疗前均有明显改善,差异均有统计学意义(t分别=2.85、2.72、2.45、-2.91,P均<0.05);治疗后3 d治疗组较对照组改善明显,差异均有统计学意义(t分别=2.32、2.62,P均<0.05)。治疗组患者MODS发生率和28 d死亡率均明显优于对照组,差异均有统计学意义(χ2分别=4.08、4.59,P均<0.05)。结论CVVH联合HP和单纯CVVH均能有效清除脓毒血症休克患者血浆中LPS及TNF-α、IL-1β、IL-6,改善单核细胞的分泌功能,调节免疫功能,改善临床症状。但CVVH联合HP在降低血浆中炎性介质浓度、LPS浓度,改善单核细胞分泌功能及提高患者Objective To investigate the effect of continuous veno-venous hemofiltration （CVVH） combined with hemoperfusion （HP） on secretory function of monocytes in patients with septic shock. Method A total of 60 patients with septic shock were randomly divided into treatment group and control group. On the basis of routine medical treatment, the treatment group was treated with CVVH and HP once a day while the control group was treated with CVVH. The course of treatment was three days. The concentration of LPS, TNF-α, IL-1β and IL-6 were measured by ELISA at pre-treatment, the first day and third day after treatment. The monocytes was stimulated with LPS in vitro. The levels of TNF-α and IL-6 of monocytes were determined by ELISA. The multiple organ dysfunction incidence, 28-day mortality were analysed. Results Compared with pre-treatment, the concentration of LPS, TNF-α, IL-1β and IL-6 of two groups who were treated after one day were reduced, but the differences were not statistically significant （t=0.44,0.98,1.02,1.24;0.53,0.83,1.25,1.11 ,P〉0.05）. The difference of secretory function of monoeyte between two groups were not statistically significant （t=-1.26,-0.92,-1.32,-0.91, P〉0.05）. LPS, TNF-α, IL-1β and IL-6 of two groups who were treated after 3 days were significantly decreased （t= 3.68,4.74,2.58,2.42; 2.43,4.01,2.47,2.43, P〈 0.05 ）, the treatment group was lower than that of the control group （t=3.07,2.59,2.40,3.13,P〈0.05）. Mononuclear cell secretion function of two groups were significantly improved compared with pre-treatment （t=2.85,2.72,2.45,-2.91 ,P〈0.05）. After 3 days of post-treatment, the differences of TNF-α and IL-6 between treatment group and control group were statistically significant （t=2.32,2.62,P〈0.05）. The multiple organ dysfunction incidence and 28--day mortality rates of the treatment group were significantly lower than that of the control group, the difference was statistically signifieant（χ2=4.08,4.59,P〈0.05）. Conclusions Both CVVH a

关 键 词：持续性血液净化 血液灌流 脓毒性休克 单核细胞功能 

分 类 号：R459.7[医药卫生—急诊医学]