Effect Of Continuous Blood Purification On The Plasma Levels Of Inflammatory Mediators In Patients With Systemic In Flammatory Response Syndrome And Acute Renal Failure

Objective: To investigate the effect of continuous blood purification (CBP) on the balance of pro-inflammatory and anti-inflammatory cytokines, hemodynamics and prognosis of patients with systemic inflammatory response syndrome (SIRS) and acute renal failure (ARF). Materials and Methods: Sixteen patients with SIRS and ARF in intensive care unit of our hospital were scheduled for the treatment of CBP. Nine of these patients are male, and seven female. Mean age was 60.6?2.0 years old. All patients were satisfied the criteria of SIRS and ARF. Except for routine monitors, mean invasive arterial pressure was monitored, and arterial blood gas analyzed by the catheter of radial artery. The change of hemodynamics was monitored by Swan-Ganz catheter, which was put in through the right jugular vein. A double trunk catheter was put into the right femoral vein and the CBP was done with the Diapact CRRT. The replacement liquid was put in by the pattern of pre-dilution. The flow was from 3000m1 to 4000m1 per hour. The blood flow was from 200m1 to 300m1 per minute. The volume of ultrafiltration depended on the volume of treatment and the volume of physiological need. Treatments included the mangement of primary disease and maintenance of main organ or system function. The I-IIR, MAP, PAWP, CVP, CO, CI, SVR and PVR, blood biochemical markers including electrolytes, urea nitrogen and creatine, plasma cytokines and arterial blood gas were recorded or measured at Oh, 2h, 4h, 6h following CBP and 6h post-CBP. The concentration of plasma cytokines was measured by ELISA. Results: No significant difference was found in the parameters of hemodynamics except for HR significant decrease following CBP. There was no significant difference in blood Nat, CF, Glu, pH, PaCO2 after CBP compared with those pre-CBP. But BUN, 5cr and serum K~ levels decresed significantly following CBP. The plasma concentrations of ? TNT- Q ,IL-1 P ,IL-2,IL-2R and IL-8 decreased gradually with the marked reduction in plasma TNIF- Q and IL-i P at 2h,4h and 6h and in plasma JL-2,IL-2R and 11-8 at 4h and 6h following CBP. The plasma levels of above cytokines increased at 6h post-CBP, but were still higher than those before CBP. There was no significant difference in the plasma concentration of IL-6, IL-4 and IL- 10 at any time following CBP and post-CBP compared with those before CBP. Conclusion: CBP could remove many inflammatory cytokines in plasma,and plove the blood biochemical markers including BUN-. Scr and serum K+ with little harmful effect on hemodynamics in patients withSmSme.