连续性血液净化治疗对多器官功能障碍综合征患儿血清细胞因子的影响

摘要

Objective To investigate the effects of continuous veno-venous hemofiltration therapy (CVVH) on the serum cytokines level in children with sepsis (Sepsis) and multiple organ dysfunction syndromes (MODS). Methods 15 cases of MODS were given CVVH treatment addition with the basis treatment, such as antibiotics, vasoactive drugs, nutritional support therapy, the maintenance of water quality of acid-base balance, and mechanical ventilation. Serum levels of cytokines TN F-α, IL-1, IL-6 were measured at 0h, 24h and 48h. According to the result, 15 cases were divided into the survival group and the death group, and compared with serum levels of cytokines TNF- α, IL-1, IL-6 of two groups, the number of organ MODS, PCIS , time of onset to CVVH and the total time of CVVH were compared. Results TNF- α was decreased at 24h and 48h, IL-1 was decreased at 48h, IL-6 was decreased at 24hand 48h , the difference was significant (P<0.05), Serum levels of cytokines TNF-α , IL-6 of death group at 0h, 24h, 48h were higher than those of the survival group, IL_1 of death group was not significant compared with survival group(P>0.05). The average number of organs of death group was higher than that of survival group, PCIS lower than the survival group the difference was significant (P<0.05), time of onset to CVVH and total time of CVVH had no significant difference (P>0.05).Conclusion CVVH can quickly and effectively remove the cytokines , CVVH treatment can improve the prognosis and survival rate if used as early as possible.%目的 探讨连续性静脉-静脉血液滤过疗法(CVVH)对脓毒症(Sepsis)并多器官功能障碍综合征(MODS)患儿血清细胞因子的影响.方法 15例MODS患儿给予抗生素、血管活性药物、营养对症支持治疗、维持水电解质酸碱平衡、机械通气基础上,进行CVVH治疗.分别取治疗前0 h,开始24 h,48 h为观察点,抽血检测血清细胞因子TNF-α,IL-1,IL-6,根据治疗结果分为存活组和死亡组,并比较两组的细胞因子TNF-α,IL-1,IL-6水平变化,比较两组治疗前功能障碍累及器官个数、PICS评分、发病到开始CVVH治疗时间、CVVH治疗总时间.结果 在治疗24 h、48 h时TNF-α的浓度(52.66±18.72)pg/ml、(46.14±27.53)pg/ml较治疗前(68.59±16.84)Pg/ml明显下降,血清IL-1水平在48 h为(21.46±2.34)Pg/ml较治疗前(27.28±3.82)pg/ml有显著下降,IL-6在治疗24 h、48 h的浓度(158.04±50.32)pg/ml、(114.61±25.69)pg/ml较治疗前(203.46±52.78)pg/ml,明显下降,差异有显著性(P<0.05),死亡组0 h、24h、48h的细胞因子TNF-α、IL-6水平均高于存活组,差异有显著性(P<0.05),死亡组0 h、24 h、48 h的IL-1水平与存活组差异无显性(P>0.05).死亡组治疗前平均累及的器官个数高于存活组,差异有显著性(P<0.05),PCIS低于存活组(P<0.05),发病到进行CVVH治疗时间和CVVH治疗总时间两组比较差异无显著性(P>0.05).结论 运用CVVH治疗儿童MODS可以迅速有效地清除细胞因子,尽早进行CVVH治疗改善预后,提高存活率.