摘要
目的：研究不同工作参数下的血浆透析滤过（plasmadiafiltration,PDF）对体外脓毒症模型不同分子量物质的筛系数、清除率,以此评价PDF的有效性与安全性。方法：用脂多糖刺激健康献血员的全血建立体外脓毒症模型。采用Evacure2A滤器行PDF,依次将以下参数组合来设定机器：血流量固定在150mL.min-1;置换液流量分别为400、800mL.h-1;透析液流量分别为2 000、4 000mL.h-1;超滤率分别为0、300、600mL.h-1。在PDF0、60min、120min后采样,测定不同PDF工作参数下的肌酐、白蛋白、炎性与抗炎介质的筛系数、清除率。结果：大多数被测物质的筛系数不受置换液流量、透析液流量、超滤率变化的影响;在行PDF60min后,大多数被测物质的筛系数较基线降低10%~60%,但随后就能保持稳定。在行PDF1h后,被测物质浓度的降幅在50%以上,血肌酐浓度的降幅为91.54%±5.40%。肿瘤坏死因子-α（TNF-α）、白介素-2（IL-2）、白介素-6（IL-6）、肌酐的总清除率在PDF120min后分别为56.75±8.65mL.min-1、66.54±8.20mL.min-1、11.46±2.45mL.min-1、117.50±10.61mL.min-1。白蛋白的总清除率在基线为2.02±1.39mL.min-1,120min后降为0.28±0.15ml.min-1。结论：在白蛋白丢失率控制在临床可接受范围内的前提下,采用Evacure2A滤器行PDF能有效、稳定地清除脓毒症常见的炎性与抗炎介质。
Objective：To investigate the effect of plasmadiafiltration（PDF） with different operating parameters on the sieving coefficients and clearance rates of different molecular weight substance in an in vitro sepsis model.Methods： In vitro sepsis model was constructed by exposure of human whole blood to bacterial lipopolysaccharide.PDF was performed with a filter named Evacure 2A and the operating parameters which would be combined in turn were set as following： fixed blood flow rate 150 mL·min-1;dialysate flow rate 2 000,4 000 mL·h-1;replacing fluid flow rate 400,800 mL·h-1;net ultra filtration rate 0,300,600 ml/h.After 0,1,2 hours′ PDF with different combination of operating parameters,samples were taken from the blood and ultrafiltration circuit to test the sieving coefficient and clearance rate of inflammatory factors.Results： Most sieving coefficients did not change with replacing fluid flow rate,dialysate flow rate,and ultrafiltration rate.Sieving coefficients of different solutes ranged from 0.1 to 1.0 at first,decreased 10%~60% after 1 hour′s PDF,and then kept stable.Concentrations of most solutes decreased more than 50% after 1 hours′ PDF,meanwhile the reduction rate of serum creatinine was 91.54%±5.40%.After 2 hours′ PDF,total clearance rate of tumor necrosis factor-α（TNF-α）,interleukin-2（IL-2）,interleukin-6（IL-6） and creatinine could still be maintained at 56.75 ± 8.65 mL·min-1,66.54±8.20 mL·min-1,11.46±2.45 mL·min-1,117.50±10.61 mL·min-1,respectively.Total clearance rate of albumin was 2.02±1.39 mL·min-1 at baseline,and then reduced to 0.28±0.15 mL·min-1 after 2 hours′ PDF.Conclusions： PDF with Evacure 2A plasma separator can remove almost all of the inflammatory mediators commonly seen in sepsis.It can provide an acceptable balance between high cytokine and low albumin clearances.
出处
《中国临床医学》
2010年第3期303-308,共6页
Chinese Journal of Clinical Medicine
基金
国家科技部"国家科技重大新药创制"专项基金(编号:2008ZX09312-010)
关键词
血浆透析滤过
脓毒症
筛系数
Plasmadiafiltration
Sepsis
Sieving coefficient
