| MODS is one of the most common causes of the death in critical cases. According to the well accepted "double- hit and overwhelming inflammation" hypothesis, the overwhelming inflammation following double- hit would be the most important course in the pathogenesis of MODS. When inflammatory cells are stimulated, several intracellular signal transduction pathway will be traggered, which regulate the reproduction and transcription of inflammatory associated gene, and finally cause the over-releasing of inflammatory factors. It is an important subject to discover the exact role of MODS in severe diseases, which could be helpful in remoting the survival rate of MODS patients.It is confirmed that the dynamic changes of cytokines have close relationship in the role of MODS, some of them are more important such as TNF-α, IL-6 and IL-8. Much more have showed that those cytokines are all over- expressed in the process of MODS and maybe the "center links". To reduce or even remove the associated cytokines may block SIRS or reduce the incidence sequentially, it would be helpful clinically in prevention and treatment for MODS. Continuous blood purification (CBP) may get this goal.CBP has been used in more dysfunctions than acute renal failure (ARF), such as MODS. Appropriate using of CBP may improve the survival rate of MODS patients. In this study, highvolume hemofiltration (HVHF), one type of CVVH, was adopted to treat the model animals whose organic function would be observed pre- and pro- HVHF. In this study, we investigated the role of cytokines and the pathogenesis in MODS, providing new way and theoretical basis for clinical prevention and treatment. In first part of the research a new pig MODS model was successfully set up with the combination of hemorrhagic shock and endotoxin. Methods: 15 pigs (male, 25～30kg) were randomly divided into three groups,model group(n=9) and control group(n=6), which were subjected to hemorrhagic shock plus resuscitation and endotoxiemia. By the hemospasia method, mean arterial pressure was decreased to 40～50 mmHg for 2h in model group. Then 60% of the lost blood and the double volume of equilibrium liquid were transfused back into the pigs for resuscitation. 12 hours later, 1mg/kg of endotoxin was given via vein. Blood specimens were collected at pre-hemorrhage and terminal for serum AST, Cr, BUN and blood gas analysis, which were used to judge if MODS happened comparing with itself. The pathomorphology of major organs were observed. The results showed that during the process, the AST, Cr, BUN of group model were obviously increased and PaO2 was decreased significantly. The incidence of single organ failure was 77.8% in lung, and 66.7% in gastrointestinal tract, 55.6% in liver, 33.3% in kidney, 33.3% in coagulation system and 22.2% in heart. The morbidity and mortality of MODS in group model were much higher than that in control group. The pig MODS model can be successfully reproduced by the use of double- hit. This model has high morbidity, high repetition, and much simulates clinical features of MODS. In the second part, the effect of HVHF on the organic function of model pigs was investigated. How to increase the survival rate of MODS patients used to be difficult. In this study, we adopted HVHF and observed serum index of organic function before and after HVHF. Methods: The process of setting up the model was the same as the first part. In the HVHF group, the animals were treated 12 hours everyday for three days, the filters were changed every 12 hours. The results showed that after treatment with HVHF for 2 days, the serum index of AST, Cr, BUN in group HVHF were obviously reduced and much lower than that in model group. PaO2 was also increased significantly. The morbidity and mortality of MODS in HVHF group were much lower than those in model group. It was showed that in HVHF group, the function of cardiovascular and blood flow, electrolyte and acid- base disturbance remained stable, but serum indexes of BUN, Cr, AST were obviously reduced. HVHF could r...
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