Objective To investigate the effects of different intensities of continuous venovenous hemodiafiltration on swine model of severe sepsis. Methods The subjects were randomly assigned into two groups, Group A ( n = 12, low dosage group) and Group B (n = 12, high dose) , in which bolus and double intravenous injection of endotoxin E. co-liolll: B4 (18.5 μg/kg) were given to the subjects, respectively. The subjects in Group A and Group B were further randomly divided into 6 subgroups, Group Al and Bl (control groups) , Group A2 and B2 with low — intensity CVVH (24 h Kt/V = 1. 12) , Group A3 and B3 with HVHF ( 24 h Kt/V = 2. 25). The ultrafiltration balance in each subgroup was 0. The vital signs were measured at different time points; with the serum cytokines, including interleukin —6 (IL — 6) , tumor necrosis factor — α ( TNF — α) and IL — 10, measured using specific enzyme — linked immunosorbent assays (ELISA). Results The survival time was significantly prolonged by CVVH and HVHF, between which there was no significant difference. With the different intensities of hemofiltration therapy, the plasma levels of cytokines (IL — 6, IL — 10, and TNF — α) were not inhibited, which was constant with the severity of sepsis. Conclusion CVVH could effectively prolong the survival time of animals with sepsis, though no superior effect is observed in HVHF.%目的 研究不同强度的血液滤过处方对不同严重程度脓毒症猪的影响.方法 动物随机分成2组,低剂量组(A组,n=12)为内毒素E.colio111:B4按照18.5 μg/kg静脉注射,高剂量组(B组,n=12)为在第1次给药后的第6小时按照同样的剂量和速度重复静脉注射1次内毒素.A组和B组各随机等分成3个亚组,其中A1、B1组为对照组,A2、B2组为低强度CVVH组(24 h Kt/V=1.12),A3、B3组为HVHF组(24 h Kt/V=2.25),各组超滤平衡为0.监测动物生命体征,测定不同时点血浆细胞因子水平如IL-6、TNF-α和IL-10以及评价其各组动物的生存率.结果 各治疗组动物存活时间明显长于对照组,但治疗组间动物存活时间差异无统计学意义.不同强度的血液滤过治疗后,脓毒症猪血浆细胞因子水平并未在各个观察时间点得到抑制,脓毒症较重的动物细胞因子水平更高,这种趋势没有被血液滤过治疗改变.结论 CVVH能够有效延长脓毒症动物的生存时间,HVHF没有比CVVH更为优越.
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