连续静脉-静脉血液滤过对严重腹腔感染血浆内毒素及细胞因子清除能力研究  

Effect of continuous veno-venous hemofiltration on the plasma levels of endotoxin and cytokine in patients with severe intra-abdominal infection

作　　者：杨帆[1] 赵允召[1] 陈钰[1] 张凯悦[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所南京大学临床学院,江苏南京210002

出　　处：《中国实用外科杂志》2014年第5期444-446,共3页Chinese Journal of Practical Surgery

摘　　要：目的研究严重腹腔感染病人行连续静脉-静脉血液滤过(CVVH)治疗前后血浆中内毒素及细胞因子的变化情况,评价CVVH对严重腹腔感染病人血内毒素及细胞因子的清除能力及其影响因素。方法 2010年9月至2011年9月南京军区南京总医院筛选ICU 21例接受CVVH的严重腹腔感染危重病人,观察行CVVH治疗前后72 h血浆中内毒素、TNF-α、IL-10的变化。入组病人分为每24h更换滤器组(10例)和血凝更换滤器组(11例)。结果严重腹腔感染病人行CVVH治疗24h后血浆中内毒素及TNF-α水平明显下降(P<0.05),IL-1048h后明显下降。每24 h置换滤器组内毒素水平在48及72 h维持在较低水平(P<0.05)。结论 CVVH可有效清除严重腹腔感染病人血浆中内毒素和细胞因子TNF-α、IL-10。24 h内更换滤器有益于血浆中内毒素的清除,并将血浆内毒素维持在较低水平。Objective To investigate the clearance effect of continuous veno-venous hemofiltration（CVVH）on plasma endotoxin and cytokine in patients with severe intra-abdominal infection, and evaluate its clear ability and influence factors on endotoxin and cytokine in patients with severe intra-abdominal infection. Methods Twenty-one patients with severe intra-abdominal infection in ICU were enrolled for the CVVH treatment carried out between September 2010 and September 2011 in Nanjing General Hospital of Nanjing Military Command to observe the plasma changes of endotoxin, TNF-α, IL-10 during the treatment in 72h. The patients were divided into two groups： the filters were replaced every 24h group （n=10） and the control group （n=11）. Results Plasma endotoxin and TNF-αdecreased significantly at 24h after CVVH treatment （P〈0.05）. Yet, the level of IL-10 began to decrease at 48h after CVVH treatment. The plasma endotoxin maintained on low level at 48h and 72h after CVVH treatment in the observation group compared with the control group（P〈0.05）. Conclusion Plasma endotoxin and cytokines （TNF-α, IL-10） can be removed effectively with CVVH in patients with severe intra-abdominal infection. CVVH has a positive effect on accelerate the removal of the plasma endotoxin and maintain a low level when replace the filter every 24 hours.

关 键 词：严重腹腔感染 连续静脉静脉血液滤过 内毒素 细胞因子 脓毒症 

分 类 号：R459.5[医药卫生—治疗学]