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目的:探讨血液滤过对严重烧伤脓毒症合并高钠血症病人的疗效。方法:应用持续静脉—静脉血液滤过方法治疗8例严重烧伤脓毒症合并高钠血症的病人。观察病情、外周血电解质、血流动力学、氧摄取率变化;检测血滤开始时、血滤结束时血浆内炎性介质(IL-1β、IL-6、IL-8和 TNF-α)浓度变化以及滤液中上述炎性介质的含量,计算跨膜清除率。结果:病人经血液滤过治疗后,临床症状好转,血流动力学趋于稳定,血钠浓度恢复至生理水平。动脉血氧饱和度、氧分压以及氧摄取率均明显升高,差异有显著意义(P<0.01)。血滤结束时血浆内IL-1β、IL-6、IL-8和 TNF-α的浓度较血滤前明显下降,差异有显著意义(P<0.01)。超滤液中也检测到上述4种细胞因子。随血滤时间延长,IL-1β、IL-6跨膜清除率明显下降,差异有显著意义(P<0.01),IL-8和 TNF-α跨膜清除率无明显变化,差异无显著意义(P>0.05)。结论:血液滤过能在较短的时间内平稳而有效降低病人外周血钠离子浓度,并能部分清除体内 IL-1β、IL-6、IL-8和 TNF-α等炎性介质,平衡机体炎性反应,稳定血流动力学、改善病情,对治疗烧伤脓毒症伴发的高钠血症,降低其高病死率有积极作用。
Objective: To investigate the effect of hemofiltration on patients with severe burn sepsis and hypernatremia. Methods: Eight patients with severe burn sepsis and hypernatremia were treated with continuous venovenous hemofiltration. The levels of IL-1β, IL-6, IL-8 and TNF-α in the plasma were measured at the beginning of the hemofiltration and at the end of the hemofiltration. Changes and the filtrate of the above inflammatory mediator content, calculated transmembrane clearance. Results: After the hemofiltration, the clinical symptoms improved, the hemodynamics tended to be stable, and the serum sodium concentration returned to the physiological level. Arterial oxygen saturation, oxygen partial pressure and oxygen uptake rate were significantly increased, the difference was significant (P <0.01). The levels of IL-1β, IL-6, IL-8 and TNF-α in the plasma at the end of the hemofiltration were significantly lower than those before the blood filtration (P <0.01). The above four cytokines were also detected in the ultrafiltrate. The transmembrane clearance of IL-1βand IL-6 decreased significantly with the time of hemofiltration (P <0.01), while there was no significant difference in the clearance of IL-8 and TNF-α P> 0.05). Conclusion: Hemofiltration can reduce the concentration of Na + in peripheral blood of patients in a relatively short period of time and partially eliminate the inflammatory mediators such as IL-1β, IL-6, IL-8 and TNF-α, and balance the body Inflammatory reaction, stabilization of hemodynamics, and improvement of the disease have a positive effect on the treatment of hypernatremia associated with burn sepsis and reduction of its high mortality rate.