连续性血液净化对外科危重病人静息能量代谢的影响

发布时间：2019-04-19 00:43

【摘要】：目的：探讨连续性血液净化(continuous blood purification,CBP)治疗对外科危重患者并发全身炎症反应时静息能量代谢的影响及其临床意义。为外科危重患者的代谢变化和代谢调理的研究提供依据。方法：本研究共收集29例外科ICU中并发全身炎症反应需行CBP治疗的危重患者,分别在CBP治疗前(即Oh)、治疗24h后、治疗48h后由间接能量代谢仪测定患者静息能量消耗(rest energy expenditure, REE)的实际值和预测值,在同一时间点留取血液标本并离心,检测血液应激激素(皮质醇、肾上腺素)、促炎细胞因子(IL-6, IL-8)、抗炎细胞因子(IL-4, IL-10),记录血常规、血生化结果和营养支持情况,观察生命体征变化。结果：危重患者并发全身炎症时由于血清中应激激素的浓度明显升高,各种免疫细胞的激活导致细胞因子的大量合成与释放,处于高分解代谢状态,此时患者的静息能量消耗较正常显著增高。患者通过CBP治疗24h、48h后,静息能量代谢较0h时明显下降(p0.05)。患者血清中的应激激素(皮质醇、肾上腺素)的浓度明显降低,血清IL-6、IL-10含量明显下降(p均小于0.05),但是IL-4、IL-8水平未发现显著差异。结论：在外科危重病患者并发全身炎症反应的情况下,及时采用CBP治疗,可以有效减少患者血清中的应激激素及炎症介质浓度,并且通过调节置换液的温度可降低体温,改善全身炎症反应患者的高代谢状态。
[Abstract]:Aim: to investigate the effect of continuous blood purification (continuous blood purification,CBP) therapy on resting energy metabolism in critically ill surgical patients complicated with systemic inflammatory reaction and its clinical significance. It provides a basis for the study of metabolic changes and metabolic conditioning in critically ill surgical patients. Methods: a total of 29 critically ill patients with systemic inflammatory response to CBP in surgical ICU were collected before CBP treatment (i.e. 24 hours after Oh), treatment). After 48 hours of treatment, the actual and predictive values of resting energy expenditure (rest energy expenditure, REE) were measured by indirect energy metabolizer. Blood samples were collected at the same time and centrifuged to detect blood stress hormones (cortisol, adrenaline). Pro-inflammatory cytokines (IL-6, IL-8), anti-inflammatory cytokines (IL-4, IL-10), blood routine, blood biochemical results and nutritional support were recorded, and the changes of vital signs were observed. Results: in critically ill patients with systemic inflammation, the concentration of stress hormone in serum was significantly increased, and the activation of various immune cells resulted in the synthesis and release of cytokines, which were in a state of high catabolism. At this time, the patient's resting energy consumption was significantly higher than normal. After treatment with CBP for 24 h, resting energy metabolism decreased significantly after 48 h compared with that at 0 h (p0.05). The concentration of stress hormone (cortisol, epinephrine) in serum was significantly decreased and the content of serum IL-6,IL-10 was significantly decreased (p < 0.05), but there was no significant difference in the level of IL-4,IL-8 between the two groups. Conclusion: in the case of severe surgical patients complicated with systemic inflammatory reaction, timely treatment with CBP can effectively reduce the concentration of stress hormones and inflammatory mediators in the serum of the patients, and reduce the body temperature by adjusting the temperature of the replacement solution. Improve the hypermetabolism of patients with systemic inflammatory response.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R605.97;R459.5

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