【摘要】：目的：探討連續(xù)性血液凈化(continuous blood purification,CBP)治療對外科危重患者并發(fā)全身炎癥反應時靜息能量代謝的影響及其臨床意義。為外科危重患者的代謝變化和代謝調(diào)理的研究提供依據(jù)。方法：本研究共收集29例外科ICU中并發(fā)全身炎癥反應需行CBP治療的危重患者,分別在CBP治療前(即Oh)、治療24h后、治療48h后由間接能量代謝儀測定患者靜息能量消耗(rest energy expenditure, REE)的實際值和預測值,在同一時間點留取血液標本并離心,檢測血液應激激素(皮質(zhì)醇、腎上腺素)、促炎細胞因子(IL-6, IL-8)、抗炎細胞因子(IL-4, IL-10),記錄血常規(guī)、血生化結(jié)果和營養(yǎng)支持情況,觀察生命體征變化。結(jié)果：危重患者并發(fā)全身炎癥時由于血清中應激激素的濃度明顯升高,各種免疫細胞的激活導致細胞因子的大量合成與釋放,處于高分解代謝狀態(tài),此時患者的靜息能量消耗較正常顯著增高�；颊咄ㄟ^CBP治療24h、48h后,靜息能量代謝較0h時明顯下降(p0.05)�；颊哐逯械膽ぜに�(皮質(zhì)醇、腎上腺素)的濃度明顯降低,血清IL-6、IL-10含量明顯下降(p均小于0.05),但是IL-4、IL-8水平未發(fā)現(xiàn)顯著差異。結(jié)論：在外科危重病患者并發(fā)全身炎癥反應的情況下,及時采用CBP治療,可以有效減少患者血清中的應激激素及炎癥介質(zhì)濃度,并且通過調(diào)節(jié)置換液的溫度可降低體溫,改善全身炎癥反應患者的高代謝狀態(tài)。
[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.
【學位授予單位】：南京大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R605.97;R459.5

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