论文部分内容阅读
目的观察连续性血液透析滤过(CVVHDF)和高容量血液滤过(HVHF)对多器官功能障碍(MODS)犬器官功能和细胞因子白细胞介素-1(IL-1)、IL-4的影响,探讨两种治疗模式对MODS的治疗效果。方法 18只Beagle犬采用失血性休克+复苏再灌注+内毒素血症建立MODS模型,随机分为CVVHDF组(n=6)、HVHF组(n=6)和MODS组(n=6)。内毒素注射完毕后CVVHDF组、HVHF组接受相应血液净化治疗24 h。测定各时间点血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Scr)、尿素氮(BUN)、动脉血氧分压(Pa O2)及二氧化碳分压(Pa CO2),应用酶联免疫吸附测定法(ELISA)测定IL-1和IL-4浓度。结果血液净化治疗后血浆IL-1、IL-4浓度在各时间点均明显下降,差异有统计学意义(P<0.05或P<0.01)。与HVHF组相比,CVVHDF组IL-1、IL-4浓度在内毒素注射完后6 h明显升高,在内毒素注射完后24 h明显下降,差异有统计学意义(P<0.05)。血液净化治疗后动物各器官功能均得到改善。与HVHF组相比,CVVHDF组Pa O2值在注射内毒素后12 h明显升高,差异有统计学意义(P<0.05)。与HVHF组相比,CVVHDF组Scr、BUN在注射内毒素后15 h、24 h明显升高,差异有统计学意义(P<0.05或P<0.01)。与HVHF组相比,CVVHDF组ALT值在注射内毒素后15 h明显降低,差异有统计学意义(P<0.01);AST值在注射内毒素后6 h、12 h明显降低,差异有统计学意义(P<0.01)。结论 CVVHDF与HVHF均可以改善组织缺氧,减轻肝、肾、肺功能损伤。HVHF对炎症介质的清除更优于CVVHDF。
Objective To investigate the effects of continuous hemodialysis (CVVHDF) and high-volume hemofiltration (HVHF) on organ function and interleukin-1 (IL-1) and interleukin-4 (IL-4) in multiple organ dysfunction (MODS) , To explore the therapeutic effect of two treatment modalities on MODS. Methods 18 Beagle dogs were randomly divided into CVVHDF group (n = 6), HVHF group (n = 6), and MODS group (n = 6) for establishing models of MODS with hemorrhagic shock + resuscitation and endotoxemia. After the endotoxin injection, CVVHDF group and HVHF group received corresponding blood purification for 24 hours. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Scr), blood urea nitrogen (BUN), arterial oxygen pressure (Pa O2) and carbon dioxide partial pressure (Pa CO2) , And the concentrations of IL-1 and IL-4 were measured by enzyme-linked immunosorbent assay (ELISA). Results After the blood purification treatment, the concentrations of plasma IL-1 and IL-4 were significantly decreased at all time points, with statistical significance (P <0.05 or P <0.01). Compared with HVHF group, the concentrations of IL-1 and IL-4 in CVVHDF group were significantly increased at 6 h after endotoxin injection and significantly decreased at 24 h after endotoxin injection (P <0.05). Blood purification treatment of animal organs have been improved. Compared with HVHF group, PaO2 values in CVVHDF group increased significantly at 12 h after injection of endotoxin, the difference was statistically significant (P <0.05). Compared with HVHF group, Scr and BUN in CVVHDF group increased significantly at 15 h and 24 h after injection of endotoxin, the difference was statistically significant (P <0.05 or P <0.01). Compared with HVHF group, the ALT value of CVVHDF group decreased significantly 15 h after injection of endotoxin, the difference was statistically significant (P <0.01); AST value decreased significantly at 6 h and 12 h after injection of endotoxin, the difference was statistically significant Significance (P <0.01). Conclusions Both CVVHDF and HVHF can improve tissue hypoxia and reduce liver, kidney and lung injury. HVHF clears inflammatory mediators better than CVVHDF.