摘要
目的前瞻性观察连续性静脉静脉血液滤过(CVVH)治疗心脏术后伴急性肾衰竭(ARF)的多脏器功能障碍综合征(MODS)患者氧化应激指标的变化。方法16例心脏术后伴ARF的MODS患者使用HF700型聚砜膜血滤器行CVVH治疗。分别在治疗前和治疗后2、61、2、24和48 h取血检测血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)和总抗氧化能力(TAC)指标的变化,同时对患者进行动态APACHEⅢ评分和MODS评分。结果①与健康对照组相比,心脏术后伴ARF的MODS患者TAC、SOD升高,GSH-Px明显下降,MDA显著升高。②心脏术后伴ARF的MODS患者TAC在CVVH治疗2 h后明显下降,SOD在治疗6 h后明显下降,MDA在治疗24 h后明显下降,在上述各时间点后TAC、SOD、MDA随治疗时间延长有不断下降趋势;GSH-Px在CVVH治疗2 h后较治疗前明显下降,6 h后随治疗时间延长有不断升高趋势,但较治疗前无明显变化。③CVVH治疗2 h后,APACHEⅢ评分即可改善,并随着治疗时间的延长有不断下降趋势。CVVH治疗24 h后,MODS评分获得改善,同时随治疗时间延长有下降趋势。结论①心脏术后伴ARF的MODS患者发生了氧化应激。②CVVH能改善心脏术后伴ARF的MODS患者的氧化应激,减轻氧化损伤。③CVVH能改善心脏术后伴ARF的MODS患者的病情。
Objective To evaluate prospectively the effect of continuous veno- venous hemofiltration（CVVH） on oxidative stress levels in the patients with acute renal failure（ARF） and multiple organ dysfunction syndrome（MODS） after cardiac surgery.Methods Sixteen patients with ARF and MODS after cardiac surgery were treated with CVVH（ used HF700 hemofilter）. The serum levels of malonyldialdehyde （MDA） ,superoxide dismutase（SOD）, glutathione peroxidase（GSH - Px） , total anti - oxidant capacity（TAC） , APACHE Ⅲ MODS scores before the start of CVVH and 2,6,12 ,24 and 48 hours after CVVH were examined and registered. Results ①Compared with healthy control group, TAC and SOD in ARF and MODS group were increased, GSH- Px was significantly decreased and MDA was significantly increased. ②After a 2- hours treatment of CVVH, TAC was significantly decreased. After a 6- hours treatment of CVVH, SOD was significantly decreased. Mter a 24 - hours treatment of CVVH, MDA was significantly decreased. They had a decreasing trend along with the time of treatment after that. After a 2 - hours treatment of CVVH, GSH - Px was significantly decreased, and it had a increasing trend along with the time of treatment, but there were no significant changes compared with 0 h. ③ After a 2 - hours treatment of CVVH, APACHE Ⅲ scores were significantly decreased, but they had a decreasing trend along with the time of treatment. After a 24- hours treatment of CVVH, MODS scores were significantly decreased, but they had a decreasing trend along with the time of treatment. Conclusions ① Oxidative stress arises in the patients with ARF and MODS after cardiac surgery. ② CVVH can hnprove the balance of oxidative and antioxidative systems and reduce damage caused by oxidative stress. ③ CVVH can improve severe state of patients with ARF and MODS after cardiac surgery.
出处
《中国急救医学》
CAS
CSCD
北大核心
2005年第9期641-644,共4页
Chinese Journal of Critical Care Medicine
基金
西京医院临床高新技术资助项目(XJGX02004Z04)
关键词
连续性静脉静脉血液滤过
多脏器功能障碍综合征
急性肾衰竭
氧化应激
心脏术后
Continuous veno- venous hemofiltration（CVVH）
Multiple organ dysfunction syndrome（MODS）
Acute renal failure（ARF）
Oxidative stress
After cardiac surgery
