持续低效血液透析滤过对蜂蜇伤后多脏器功能障碍综合征患者预后及炎症因子的影响

摘要

Objective To observe effecls of sustained low - efficiency diafillralion ( SLEDF) on prognosis and inflammatory cylokine in palienls with multiple organ dysfunclion syndrome (MODS) following wasp sling and Lo invesligale the therapeulic aclion of SLEDF for the palienls wilh MODS following wasp sling. Methods Twenly - nine palienls wilh MODS following wasp sling were randomly divided into continuous veno -venous hemofillralion (CVVH) group wilh 14 palienls and SLEDF group wilh 15 palienls. Mortality, ratio of renal healing and lime of reaching polyuria stage were observed. And score of acute physiology and chronic heallh evaluation (APACHE) II , serum levels of crealinine, tumor necrosis faclor - α ( TNF - α) , inlerleukin ( IL) - 1 (3 and IL - 10 were compared before trealmenl, on third and sevenlh day after trealmenl belween two groups. Results There were no significant differences of mortality, ralio of renal healing and time of reaching polyuria slage between two groups (P>0. 05, respectively). Scores of APACHE Ⅱ , serum levels of crealinine, TNF - α, IL - 1(3 and IL - 10 in CVVH group and SLEDF group were lower on ihird day after treatmenl than before trealmenl, and were significantly decreased on seventh day afler treatmenl ( P < 0. 05 or 0. 01, respectively). And there were no significant differences of scores of APACHE Ⅱ , serum levels of crealinine, TNF - α, IL - 1(3 and IL - 10 at three time - poinls between two groups ( P > 0. 05, respectively). Conclusion Compared wilh CVVH, SLEDF could clear inflammatory cylokine and improve prognosis in patienls with MODS following wasp sling.%目的 观察持续低效血液透析滤过(SLEDF)对蜂蜇伤后多脏器功能障碍综合征(MODS)患者预后及炎症因子的影响,探讨SLEDF对蜂蜇伤后MODS患者的治疗作用.方法 29例蜂蜇伤后MODS患者,随机分为持续静脉-静脉血液滤过(CVVH)组(14例)和SLEDF组(15例).比较两组死亡率、肾脏痊愈率和进入多尿期的时间;对比两组治疗前、治疗第3天和第7天的急性生理学与慢性健康状况评分(APACHE)Ⅱ、血肌酐(Scr)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-10的水平.结果 两组患者死亡率、肾脏痊愈率和进入多尿期的时间比较差异无统计学意义(P>0.05).在治疗第3天,两组APACHEⅡ、Scr、TNF-α、IL-1β和IL-10水平均较治疗前下降,在治疗第7天进一步下降(P<0.05或0.01);而两组APACHEⅡ、Scr、TNF-α、IL-1β和IL-10水平在3个时间点的比较差异均无统计学意义(P>0.05).结论 对于蜂蜇伤后MODS患者,SLEDF具有和CVVH相似的清除炎症因子和改善预后的作用.