高容量血液滤过联合内毒素吸附对脓毒症内皮细胞的影响

高容量血液滤过联合内毒素吸附对脓毒症内皮细胞的影响 高容量血液滤过联合内毒素吸附对脓毒症 内皮细胞的影响 jz@y ???????k?????????5?????a ?-?[???4?????????????????? ?E????,?????D (???????U?N?N??,????250011) ????:???4???????f?????????d?????k?????d????,???????????k?????????5?????a?-?[???????????? ??????Mz???P???????k?????????5?????a?-?[????Mz?0???????(?H?P???y?????a??(T1)Mj???y?660min (T2)Mj120min(T3)Mj240min(T4)Mj480min(T5)???????k???2?V,?????k?,?????a(Endothelin,ET)Mj?k???s?X?k ????????(vonwillebrandfactor,vWF)Mj?????a(Lipopolysaccharide,LPS)?;??Mz?????????d,?????????a?f?6?k ?>ETMjvWF??LPS?????X???a?f???X??5~6?T,?????64h,HVHF??ETMjvWF??LPS?????4???)??,?:???C ???P?????62h,??????ETMjvWF??LPS?????:???)??,?6?????F???????0?.???s???zMz???????k???????? ?5?????a?-?[???????????k?>LPSMjET??vWF?;??,?@??????????,????????????????,?u??DIC,???:?P?N ???4????MjMODS?n?e?m??????????(Multipleorganfailure,MOF)???????D???L???????????PMz ???I??:?4????;????????;???????k??????;?????a?-?[;?????a;?k???s?X?k???????? ?D???(????:R318???I?2???j:A?????d??:1672-6278(2011)01-0043-03 TheEffectofHighVolumeHemofiltrationand DirectEndotoxinAbsorptiononEndothlialCells LUSuyi,MENGJianzhong (JinanMilitaryAreaGeneralHospitalofPLA,Jinan250011,China) Abstract:Usinghighvolumehemofiltration(HVHF)totreatanimalmodel,toevaluatetheinfluencesofhemoperfusiononsepsis.Blood sampleswerecollectedfromallanimalsbeforeendotoxininfusion(T1,baseline)andat60(T2),120(T3),240(T4),480min(T5)after endotoxininfusion.ThedynamicchangeofET,vWF.Inadditiontothecontrolgroup,theconcentrationsofET,vWFandLPSoffourgroup animalswereincreasedsignificantly.Afterfourhoursoftreatment,theconcentrationsofLPSandcytokinesinperipheralblooddecreased significantlyafterHF.Inthetreatmentonsepsis,HFcanregulateinflammatoryresponseeffectivelyMjdecreasetheconcentrationsofLPS,ETand vWF,HFcanattenuatethecirculatinglevelofcytokines,improvemajororganfunction;protectthefunctionofendothelialcell. Keywords:Sepsis;Vascularendothelialcells;Highvolumehemofiltration;Endotoxinabsorption;Endothelin;Vonwillebrandfactor 1?E?? ?4?????C?;????????,????????????????,?C?? ???d???N???????8????????????Mz???s?u198?~ ICU3147?????,???@?????6,?4?????????????U 37%,?????4???????????????U30% [1] ;?D???????? ?@?????.?U,?P?s???N???d??ICU?D?L???4?????? ???????U8.68%,???????U48.7% [2] Mz??????,?? ???s?k?????d(continuousbloodpurification,CBP)?P?y ?????????????D?????P???o?U??20???????????? ?????????????? [3] Mz?V?8?????4???????f???????? ?d?????k?????d????,???????????k?????????5?? ???a?-?[??????????????????Mz ?r???N?????)?8?? JournalofBiomedicalEngineeringResearch 2011,30(1):43~45 Email:m90ahoo.com.cn 2?????6???? 2.1?????(?? 2.1.1???-??????(??????????)5??,?f????5 ??,???????y?????a???:?????????T?????G????15 mlkg -1 h -1 ?r?????0????MzHVHF??5??:???y?? ???a?:???????T?????G??(15mlkg -1 h -1 )?j???? ?0????;???????????y?????a?660min?????? HVHFMz???C???????k?????????5?????a?-?[ (HVHF-?????a?-?[,???????C??)??5??:???y?? ???a?:???????T?????G??(15mlkg -1 h -1 )?j???? ?0????;???????????y?????a60min???????a?-?[ ????2h,????HVHF????6hMzHVHF???????U??, ???????U40mlkg -1 h -1 ,?k?K??80mlmin -1 Mz 2.1.2???????????????????????????P?x???? PORT???????P????????(?????????P?k?????????? ???(??????),???????????r???U100m1kg.h(1 000~1500m1h),???????????????S???U37,?? ?????x???????r?(?????????????????????@??Mz 2.2?????????????6?C?j ????Mj???-Mj???c?*?-???C?jMz???-???????C?j ?????U:???d?8??Mj?-??1?fh,???-????>40?f min?d?-???8Pa0260mmHg??,???????????????- ?d???4???-?U?U???e?8Mz???????????k??????1?f h,???????m????????,????24h?;?R???P?????? ??,?????k???????T??(?P???k?????T???????)???? >2?T?????G,???X???0??70%?????G)??,???? ???0?????e???????j?k??;???c?C?j?U???????0?? ?????????G???????y????100~150m1kgdMz???? 3%???1??????????,?030mgkg???????????????y (IP),4~6h?6?????????????P????13,???????? ?j???????jMz 2.3?????2?2 ?y???????(?H?P???y?????a??(T1)Mj???y?660 min(T2)Mj120min(T3)Mj240min(T4)Mj480min(T5)?? ?????k???2?V,?????k?,?????a???k???s?X?k???? ????,???P???????x???????????-?[??????(ELISA) ?????k?,?H??Mz 2.4???????y?( ?????????????????X???2????(XS)???U, ???PSSS?????????????????y?(Mz?y?????X ?????????P?????a?????(??(NOV),?????????? ?P????Mz??????????<5?U?????????z?. ??,<?U???z???-?.??Mz 3???? 3.1?y???k?,?D?????a?????????d(????1) ?0???????k?>?D??ET?????P?:???????????? ?????6?.?X??;???6,?P?f????ET?????P2h???? ??1ET?P?????D?????d(ngml,XS) Table1ThechangeofETinfourgroups(ngml,XS) GroupT1T2T3T4T5 ??????5.410.46.021.05.60.85.71.25.90.8 ?f????5.660.928.343.025.232.125.211.927.632.6 HVHF??5.31.629.135.224.22.617.321.8 * 19.31.1 * ???C??5.431.125.543.113.211.5 7.83 1.2 **6.90.9 ** ??:*P<0.05,**P<0.018 T1-???k?G,T2-?????a???y?62h,T3-?????a???y?64h,T4-???? ?a???y?66h,T5-?????a???y?68hMz ?M??????,?A?6?4??????Mz?:?PHVHF???????C?? ???k??????????,ET???????6?.????,HVHF???6 ?f?????????0?.?????z,???C???6?f?????????0?? ???.?????zMz 3.2?y???k?,?DvWF?????????d(????2) ??2vWF?P?????D?????d(ngml,XS) Table2ThechangeofvWFinfourgroups(ngml,XS) GroupT1T2T3T4T5 ??????3.00.382.81.22.20.92.760.482.31.0 ?f????2.390.654.950.785.31.18.421.328.561.23 HVHF??2.250.534.81.14.970.986.211.06 * 6.231.0 * ???C??2.640.565.31.23.860.8 3.26 0.93 **3.410.8 ** ??:*P<0.05,**P<0.01 T1-???k?G,T2-?????a???y?????62h,T3-?????a???y???? ?64h,T4-?????a???y?????66h,T5-?????a???y?????68hMz ?0???????k?>?D???????PLPS???y?6?X???? ?????6?.?X??;???6,?P?f?????????????s?X??Mz HVHF???h?P?????a???y?62h???????X??????,?? ?k???????????h?6?.????,?6?f?????????0?.???? ?z,?:???C???6?f????????,?????????????.??Mz 4???? ?k??????????(VEC)?C?????k?????????????9 ????,???0?(???e???k???N?s???P??????,???????? ???????????s???@???k???a??Mj???kMj?????k?????? ?????????*???0?????m?*Mz??V???M?????aMj TNF?*???a?U???6,???a?i???k?????FMj???????? ?? [] Mz?V?8?????P?????????a?i???A???4?????f ??,???????k?>???????????a(T)Mj?k???s?X?k?? 44?r???N?????)?8???V30?? P12.0 AA tP0.0 P0.01 EC 4 E (vWF)?P???y?????a2h?6???????????G;?8 ET?P?????G?6?0???~?????)??Mj???1?X?????),?: vWF?h?????6?.???????k?G,???U?????????????FMj ?N?d?E?????k???N?s???P?;???z?-?????C?????4?? ???k?????????1??Mj?????????U?k?U?s?s???????? ?(?r?(???k????,VEC???F?P???????????????5?? (SIRS)???e?????????T??(MODS)?????rMj????Mj?8 ???D???L?????????PMz ET-1?C?k?????????????F???????2????,?0 ?0???z????,??ET-1MjET-2MjET-3,?(?@???k???? ??????(EC)???k????????????(VSMC)?D,?????A ?k?????????????r?????l????(EDRF)?????????? ??,???0?S?k??Mj?X?k?????????k???????????????? ?????P [6] Mz?V?????????6,?4?????f?????k?>???? ?a?;???.??????,?:?PHVHF-?????a?-?[?????6 ETMjvWF?;???6?.????,???6???f?m?????e???j??Mj ?s??Mj?4???M?,???U???????????a??????????,???: ?0?S??????????????????,?N??DIC?nMODS???? ??Mz?A?:,?V?8?????????.?U,?4?????f???????y?? ???a?6,ET???G?<?????~?????)?????1?X?????), ?:vWF?h?????6?.???????k?G,???6vWF?C???a?k ?????????????F???????r???2?2????Mz ???????? [7] ,vWF?C?????k???????????5?i?? ?s?(????????,?N????????????????Weibe-palade ?m????,???N???????0:(1)?U?p???k???????k,?? ???j???P?k???D???g???s,????????????????,???6 ?k?m??????Mj?????????????k???k?4???i???) [8] Mz (2)?6?k?m?????1?????z?s?????????5,?????????) ?k?m???????w???[Mz?????????????M?U???d???F ??,?????(???M?k?>?D?d?k???????????),?????k?m ???????[ [9] Mz(3)?k?????????????F?????k?>vWF ?;???X??,???e???????????P?(?H???k?????????? ???k?m?????1????????????(GPIb),?????k?m???? ?[??????,????,?0?8???.?U???k?U?s??????????, ?k??????vWF?H???i?i?)??,?k?DvWF?????6?.?X ?? [10] Mz?V?8??????,???PHVHF???????????????s ????,?6?f?????????0?.?????z,?:???C???6?f???? ????,?????????????.??,???6?????s?k?????d???? ???e???L??Mj???????-?[???P,?,???z?-???????k?? ?N?s???P,?U???j?????????g??,???????????????? ????Mz ?N??,???4?????J??????CBP,???r?g??Mj?X??Mj ?j???M?x???????d?????r????????,?????C?????? ????,???C???????????????????),???C?5?(??Mz ???@???I: [1]RoumenRMH,RedlH,SchlagG,etal.Inflammatorymediatorsin relationtothedevelopmentofmultipleorganfailureinpatientsafter severeblunttrauma[J].CritCareMed,1995,23:474-480. 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