Effect Of Continuous Veno-venous Hemofiltration On The Plasma Levels Of Endotoxin And Cvtokine In Patients With Severe Intra-abdominal Infection

Continuous renal replacement therapy is a common treatment in intensive care unit. The technique of CRRT has found increasing applicability in the treatment of patients with renal failure combined with cardiovascular instability, severe fluid overload, cerebral edema or hypercatabolism. With the development of the technology of CRRT, CRRT application category has extended from ARF to systemic inflammation response syndrome, septic shock, severe acute pancreatitis, explosive liver failure, etc. The treatment shows its positive effect on regulate immune status in patients with severe intra-abdominal infection (It could limit inflammation factors previously and suppress the immune attack in the later period).objective:To investigate the clearance effect of continuous veno-venous hemofiltration (CVVH) on plasma endotoxin and cytokine in patients with severe intra-abdominal infection, and evaluate its clear ability and influence factors on endotoxin and cytokine in patients with severe intra-abdominal infection.Methods:21patients with severe intra-abdominal infection in ICU were enrolled for the CVVH treatment. CVVH was adopted with FX60hemofilter for72h. The patients were divided as follows:the filters were replaced every24h group and the control group; therapeutic doses2000ml/h group and4000ml/h group. Endotoxin and cytokine were observed at Oh、24h、48h、72h.Results:Plasma level of endotoxin and TNF-α at24h after CVVH initiation were significantly lower than those before the treatment(p<0.05).However, the level of IL-10began to decrease at48h after CVVH treatment. The plasma endotoxin maintain on low level at48h and72h after CVVH treatment in replace the filters every24h group compare with the control group(p<0.05). A significant decrease in plasma TNF-α levels in therapeutic doses4000ml/h group was seen at24h and48h after treatment(p<0.05).Conclusion:Plasma endotoxin and cytokines (TNF-alpha, IL-10) can be removed effectively with CVVH in patients with with severe intra-abdominal infection. CVVH has an positive effect on accelerate the removal of the plasma endotoxin and maintain a low level when replace the filter every24hours. And it could restrain the expression of TNF-α\IL-10on sepsis patients.