连续性高容量血液滤过对多器官功能障碍综合征患者血清炎性介质水平及血管内皮功能的影响研究  

Research effect of continuous high volume hemofiltration on inflammatory factors and vascular endothelial function of patients wtih multiple organ dysfunction syndrome

作　　者：崔显念 吴钢 徐锋 樊莎莎 马娅 姜宜 黄敏 

机构地区：[1]湖北省恩施自治州民族医院检验科,445000 [2]湖北省恩施自治州中心医院输血科

出　　处：《国际输血及血液学杂志》2016年第1期18-25,共8页International Journal of Blood Transfusion and Hematology

基　　金：湖北省自然科学基金资助项目（2009CDB380）

摘　　要：目的探讨连续性高容量血液滤过（CHVHF）对多器官功能障碍综合征（MODS）患者血清炎性介质水平及血管内皮功能的影响。方法选择2013年5月至2014年6月湖北省恩施自治州民族医院收治的80例MODS患者作为研究对象。采用随机数字表法将80例MODS患者分为研究组（n=40）与对照组（n=40）。所有患者均有明确的原发疾病，且出现MODS，均符合《MODS诊断标准、病情严重度评分及预后评估系统和中西医结合证型诊断》中关于MODS的诊断标准。本研究纳入标准：年龄为35～68岁，符合MODS诊断标准，且首次行CHVHF治疗。排除标准：妊娠期妇女、接受免疫抑制治疗者及慢性肾功能衰竭者。对照组患者采用间歇性血液透析（IHD）及常规治疗方案，研究组患者在对照组治疗方案基础上进行CHVHF治疗。检测两组患者靶器官功能、血清炎性介质水平、血管内皮功能指标及治疗效果，并进行统计学分析。本研究遵循的程序符合湖北省恩施自治州民族医院医院人体试验委员会所制定的伦理学标准，得到该委员会批准，征得受试对象的知情同意，并与之签署临床研究知情同意书。两组受试对象性别构成比、年龄、原发病类型、急性生理和慢性健康状况评分系统（APACHE）Ⅱ评分、MODS评分、治疗时间等临床资料比较，差异均无统计学意义（P〉0．05）。结果①治疗前，研究组与对照组MODS患者血清淀粉酶、丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、肌酐及尿素氮水平比较，差异均无统计学意义（P〉0．05）。治疗后，研究组患者血清淀粉酶、ALT、AST、肌酐及尿素氮水平与治疗前相比，均显著减低，并且差异均有统计学意义[血清淀粉酶水平：（156．7±17．4）U／L与（316．3±45．3）U／L，t=20．671，P=0．000；血清ALT水平：（62．1±7．8）u／L与（88．3±9．3）U／L，t=13．598，P=0Objective To investigate the effect of continuous high volume hemofiltration （CHVHF） on inflammatory factors and vascular endothelial function of patients wtih multiple organ dysfunction syndrome （MODS）. Methods From May 2013 to June 2014, a total of 80 cases of patients with MODS in National Hospital of Enshi Autonomous Prefecture were included into this study. All the patients were randomly divided into study group （n = 40） and control group （n = 40）. All patients had clear primary disease with MODS, which conformed to the diagnosis of MODS in Diagnosis criteria, severity scoring system, and the prognosis evaluation system of integrated Chinese traditional and western medicine for MODS. This study inclusion criteria： the age of 35 to 68 years old, comfirmed to the MODS diagnostic criteria, and recieved CHVHF treatment for the first time. Exclusion criteria： pregnancy women, recieved immunosuppressive therapy and combined with chronic renal failure. Patients in control group received intermittent hemodialysis （IHD） treatment and conventional treatment; patients in study group received CHVHF combined with IHD treatment and conventional treatment. Then target organs function, inflammatory mediator levels, endothelial function index content, and treatment outcome were detected and compared by statistical methods. The protocol was approved by the Ethical Review Board of Investigation in Human Beings of National Hospital of Enshi Autonomous Prefecture. Informed consent was obtained from each patient. There were no significant differences of patientsr general clinical features between two groups, such as gender ratio, age, types of primary diseases, scores of acute physiology and chronic health evaluations （APACHE） U , scores of MODS and duration of treatment （P〈0. 05）. Results ① Before treatment, target organ function index of patients with MODS in two groups, such as serum amylase, alanine transaminase （ALT）, aspertate aminotransferase （AST）, creatinine and urea nitrogen l

关 键 词：多器官功能衰竭 血液滤过 炎症 内皮 血管 

分 类 号：R459.7[医药卫生—急诊医学]