高容量血液滤过对感染性休克所致 ARDS影响的实验研究  

Effect of high volume hemofiltration on acute respiratory distress syndrome caused by septic shock

作　　者：张敏[1,2] 赵平[1] 薛露[1] 郑瑞强[1] 

机构地区：[1]江苏省苏北人民医院重症医学科,扬州225001 [2]张家港市第一人民医院重症医学科,215600

出　　处：《国际呼吸杂志》2016年第3期175-181,共7页International Journal of Respiration

基　　金：江苏省“333高层次人才培养工程”基金（2011-15）

摘　　要：目的：探讨高容量血液滤过（HVHF）对感染性休克所致 ARDS 氧合情况及肺部炎症反应的影响。方法18只健康猪,静脉输注内毒素50μg/kg 诱导感染性休克模型,制模成功后随机分为三组（每组6只）：对照组、常规流量血液滤过组（NVHF 组）、HVHF 组均给予机械通气及液体复苏。分别留取造模前、造模成功时、开始血液滤过治疗1 h、2 h、3 h、4 h、5 h、6 h 的动脉血标本以行血气分析及检测血浆中 IL-6和 IL-10水平,观察结束后处死动物留取肺组织,以测定核因子κB （NF-κB）的表达和观察病理。结果动物成模时氧合指数（PaO 2/FiO 2）小于300 mmHg。氧合指数方面,血液滤过治疗第4小时开始, HVHF 组明显高于对照组（P 〈0.05）和 NVHF 组（P 〈0.05）。肺血管通透性指数（PVPI）HVHF 组从第3小时开始明显低于对照组（P 〈0.05）和 NVHF组（P 〈0.05）。休克模型建立时,IL-6和10炎症因子水平急剧升高（P 〈0.05）,血滤治疗第1小时起,NVHF 和 HVHF 两组炎症因子水平均低于对照组（P 〈0.05）,同时 HVHF 组 IL-10低于NVHF 组（P 〈0.05）,血滤治疗第4小时起, HVHF 组 IL-6明显低于 NVHF 组（P 〈0.05）。HVHF 组肺组织 NF-κB 表达明显低于对照组和 NVHF 组（P 〈0.05）。HVHF 组较其他两组肺组织出血、水肿、肺不张、代偿性肺气肿改变明显减轻。结论 HVHF 可能通过减低肺组织局部 NF-κB表达,减少血浆炎症因子,降低局部炎症反应机制,改善感染性休克所致 ARDS 的组织病理改变和氧合状态。Objective To explore the high volume hemofiltration （HVHF） on oxygenation and pulmonary inflammatory response in acute respiratory distress syndrome （ARDS） induced by septic shock.Methods 18 healthy pigs were injected endotoxin 50 μg/kg via central vein within 30 minutes. After model establishment,all pigs were randomly divided into three groups （n = 6）：control group, normal volume hemofiltration （NVHF） group and HVHF group.All the three groups were given mechanical ventilation and fluid resuscitation.Before infusion endotoxin,at Oh after shock model establishment and the point of 1,2,3,4,5,6 h after they were given hemofiltration treatment,blood was taken for the arterial blood gas analysis and the detection of IL-6,IL-10.Pigs were killed after the hemofiltration treatment was over,the lung tissue was acquired to observe pathology and measure the expression of nuclear factor-kappa B （NF-κB）.Results The oxygenation index （PaO 2/FiO 2） was less than 300 mmHg （1 mmHg = 0.133 kPa）when the model was established.After 4 hours′hemofiltration treatment,the PaO 2/FiO 2 of HVHF group was significantly higher than control group and NVHF group＆amp;nbsp;（all P 〈 0.05）.The Pulmonary vascular permeability index （PVPI）,after 3 hours′ hemofiltration treatment,the value of HVHF group was obviously lower than control group and NVHF group （all P 〈0.05）.When Shock model was established,IL-6 and IL-10 inflammatory factor levels sharply rised（P 〈0.05）.After 1 hour′s blood filtration treatment,inflammatory factor levels in NVHF and HVHF groups were lower than control group （P 〈0.05）,and at the same time,the level of IL-10 in HVHF was lower than NVHF group（P 〈0.05）.After 4 hours,the level of IL-6 in HVHF group was obviously lower than NVHF group （P 〈0.05）.The level of NF-κB in HVHF group was obviously lower than control group and NVHF group （all P 〈 0.05）.Compared with the other two groups,the lung hemorrhage,edema, atelectasis,compensatory emphysema

关 键 词：高容量血液滤过 感染性休克 急性呼吸窘迫综合症 

分 类 号：R459.7[医药卫生—急诊医学]