贵州医科大学学报

2016, v.41;No.186(03) 318-321

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HVHF治疗对脓毒血症并发ARDS患者血清TNF-α、IL-6、IL-8和IL-10水平的影响
Observation on Change of TNF-α,IL-6,IL-8 and IL-10 of Sepsis Complicated with ARDS Patients Treated by HVHF

张怡;牛丹;宗媛;董道然;尹贻明;
ZHANG Yi;NIU Dan;ZONG Yuan;DONG Daoran;YIN Yiming;ICU,Shaanxi Provincial People's Hospital;

摘要(Abstract):

目的:观察持续高容量血滤(HVHF)治疗对脓毒血症并发急性呼吸窘迫综合征(ARDS)患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8及IL-10水平的影响。方法:90例脓毒血症并发ARDS患者均分为观察组和对照组,对照组给予抗感染及原发病治疗,观察组在对照组治疗的基础上加用持续HVHF治疗,比较两组患者治疗后2、4及12 h血p H、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、吸入氧气浓度(Fi O2)与动脉血氧饱和度(PO2)比值;采用ELISA法检测两组患者治疗前及治疗后24、48及72 h血清TNF-α、IL-6、IL-8及IL-10水平。结果:与治疗前比较,随治疗时间的延长,2组患者的Fi O2/PO2和Pa O2均呈升高趋势而Pa CO2呈下降趋势(P<0.05),观察组变化更明显(P<0.05);观察组p H虽均高于治疗前(P<0.05),但随治疗时间延长呈先高后低趋势,而对照组则呈先降低后升高趋势;与治疗前比较,随治疗时间的延长,2组患者血清TNF-α、IL-6及IL-8水平呈降低趋势(P<0.05),观察组降低更明显(P<0.05),IL-10水平治疗前后变化不大(P>0.05)。结论:HVHF治疗脓毒血症合并ARDS能够提高循环中炎症因子的清除能力。
Objective: To investigate the clinical efficacy of continuous high volume blood filtration( HVHF) in treating sepsis complicated with acute respiratory distress syndrome( ARDS). Methods:90 cases of sepsis patients with ARDS were divided into observation group and control group; control group was treated with anti-infection and treatment of primary disease,observation group was treated the same with additional HVHF treatment. Comparing blood p H,Pa O2,Pa CO2,Fi O2 and PO2 of both groups in 2,4,and 12 h after treatment. Adopting ELISA method to test the level change of TNF-α,interleukin-6,IL-8 and IL-10 before and after treatment in 24,48 and 72 h. Results: With the prolonging of treatment,Fi O2/ PO2 and Pa O2 of both groups increased while Pa CO2 decreased( P <0. 05); while the change of observation group was more obvious( P < 0. 05); although p H of observation group was higher than before treatment,as the treatment lasted,p H presented in a decreasing tendency,while control group presented in increasing tendency; comparing with before treatment,with the treatment time prolonged,TNF-α,IL-6 and IL-8 level decreased( P < 0. 05); observation group decreased more obvious( P < 0. 05); IL-10 level didn't change much( P > 0. 05). Conclusion: HVHF adjuvant treatment of sepsis with ARDS can effectively improve the oxygen metabolism and the inflammatory cytokines in the circulation of scavenging ability.

关键词(KeyWords): 呼吸窘迫综合征;毒血症;持续高容量血滤;肿瘤坏死因子-α;白细胞介素
acute respiratory distress syndrome;sepsis;continuous high volume blood filtration;tumor necrosis factor alpha;interleukin

Abstract:

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基金项目(Foundation): 陕西省自然基金面上项目(No:2014JM4129)

作者(Author): 张怡;牛丹;宗媛;董道然;尹贻明;
ZHANG Yi;NIU Dan;ZONG Yuan;DONG Daoran;YIN Yiming;ICU,Shaanxi Provincial People's Hospital;

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DOI: 10.19367/j.cnki.1000-2707.2016.03.020

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