Effects Of Hemocarboperfusion On Endotoxin, Cytokines And Hemodynamics In Patients With ARDS After Severe Injury

Objective: Observing endotoxemia and cytokines in the plasma of severe injury patients, and using hemoperfusion to treat patients combined with ARDS, to evaluate the influences of hemoperfusion on endotoxin, cytokines in plasma and hemodynamics, to explore the clinical feasibility of hemoperfusion, and to provide experimental bases for using it to treat severe injure patients as an assisted method.Methods: To choose 24 severe injury cases whose ISS scores are no less than 16. GroupⅠ:severe injury cases combined without ARDS,8 cases; GroupⅡ: severe injury cases combined with ARDS,8 cases, to treat with traditional methods; Group III: severe injury cases combined with ARDS,8 cases, baseing on traditional methods, to hemocarboperfusion for 2 hours; Group Control: young blood devoter, 10 cases. To assay endotoxin, cytokines in plasma in each group at the accordant time, meanwhile in Group III to determine the changes of hemodynamics.Results: (1)The endotoxin in plasma of severe injury cases to reach the peak at the 2~nd day, TNF-α,IL-1β do the same at the 3~rd day, they descent in different degrees after that , they were still more than normal level at the 7~th day(P<0.05); IL-6,IL-8 become higher at the early period after injury, and at the 5~th ,7~th day they were higher obviously(P<0.05). (2)The endotoxin,cytokines in plasma of severe injury cases combined with ARDS were higher than those combined not(P<0.05). (3)There are positive correlations between the levels of endotoxin ,cytokines in plasma and ISS Scores in severe injury cases(P<0.05);there are positive correlations between TNF-α,IL-1β,IL-6,IL-8 and endotoxin in the plasma of severe injury patients(P<0.05). (4)Endotoxin and cytokines in plasma in Group III descent in different degrees after hemoperfusion,among these endotoxin and IL-6 are more significant(P<0.01). The levels of endotoxin and cytokines at the 1st,3~rd,5~th day after perfusion in Group III are lower than GroupⅡ at the according time(P<0.05).(5)In Group III MPAP and PVRI after hemoperfusion are lower than those before hemoperfusion significantly(P<0.05), the other changes of hemodynamics are not obvious; the values of PaO2/FiO2 after hemoperfusion are higher than that beforehemoperfusion significantly(P<0.05).Conclusions: (1)Severe injury can cause obvious endotoxemia and cytokines reactions. There is parallel between the changes of endotoxin ,cytokines in plasma after injury, and it is may be important to determine the degree of injury by monitoring these dynamic changes. (2)Endotoxin invasion greatly after severe injury at the early period may be one of the important mechanism of producing,releasing of cytokines after injury. (3) The endotoxin and cytokines in plasma in severe injury cases combined with ARDS are higher than those not combined with ARDS. Hemocarboperfusion at the early stage can improve endotoxemia obviously, block the reaction of cytokines. (4) Hemocarboperfusion can decrease MPAP and PVRI of severe injury cases combined with ARDS ,increase PaO2/FiO2,improve the respiratory function,and rarely has an effect on MAP,CVP, PCWP,CI and SVRI. Hemocarboperfusion can be carry out safely,and it may be one of the assisted therapeutics for severe injury cases combined with ARDS in the future.