Yekebas Emre F, Strate Tim, Zolmajd Sharam, Eisenberger Claus F, Erbersdobler Andreas, Saalmüller Armin, Steffani Katharina, Busch Christoph, Elsner Holger-Andreas, Engelhardt Madelaine, Gillesen Andrea, Meins Jan, The Marcel, Knoefel Wolfram T, Izbicki Jakob R
Department of Surgery, University Hospital Eppendorf, Hamburg, Germany.
Kidney Int. 2002 Nov;62(5):1806-18. doi: 10.1046/j.1523-1755.2002.00607.x.
Continuous venovenous hemofiltration (CVVH) is assumed to attenuate systemic complications in septic diseases. The impact of different treatment intensities of CVVH on immunologic and systemic alterations in experimental pancreatitis was evaluated.
Eighty-four minipigs were allocated either to an untreated control group (group 1) or to one of six treatment groups (groups 2 to 7) that underwent CVVH in different modalities: (1): "late" CVVH, started after a decline of total peripheral resistance of 30% versus "prophylactic" CVVH started immediately after the induction of pancreatitis; (2) no change of hemofilters versus a periodic change of filters every 12 hours; (3) low-volume CVVH with a filtrate turnover of 20 mL/kg body weight (BW)/h versus high-volume CVVH (100 mL/kg/h). Pancreatitis was induced by intraductal injection of sodium-taurocholate (3%, 1 mL/kg BW) and enterokinase (2 U/kg BW). We focused on the occurrence of sepsis, serum cytokines, down-regulation of major histocompatibility complex II (MHC II) and the endotoxin receptor CD14 expression, bacterial translocation/endotoxemia, and pulmonary and renal histologic alterations.
CVVH delayed or definitively prevented the occurrence of sepsis. Pancreatitis was associated with a tremendous initial tumor necrosis factor-alpha (TNF-alpha) response prior to a return to near baseline levels in the late course of sepsis. Endotoxin hyporesponsiveness, suggested by the dissociation of decreasing TNF-alpha levels and increasing endotoxemia in end-stage sepsis, was favorably influenced by CVVH. Down-regulation of MHC II and CD14 expression was prevented in non-septic animals. CVVH-related sepsis-protection led to a significant attenuation of histological injury in lungs and kidneys. "Prophylactic" CVVH prevented histological changes more effectively than "late" CVVH.
CVVH offers a therapeutic option for supportive treatment in severe pancreatitis. The efficiency of CVVH is associated with the duration of filter use and cumulative plasma turnover. Since CVVH may lead to sepsis-protection and long-term survival, further evaluation in controlled, clinical trials is warranted.
持续静静脉血液滤过（CVVH）被认为可减轻脓毒症疾病中的全身并发症。评估了不同治疗强度的CVVH对实验性胰腺炎免疫和全身改变的影响。
84只小型猪被分配至未治疗的对照组（第1组）或六个治疗组（第2至7组）之一，这些治疗组以不同方式接受CVVH：（1）“晚期”CVVH，在总外周阻力下降30%后开始，与胰腺炎诱导后立即开始的“预防性”CVVH相对；（2）血液滤过器无变化与每12小时定期更换滤器相对；（3）低容量CVVH，滤过液周转率为20 mL/千克体重（BW）/小时与高容量CVVH（100 mL/千克/小时）相对。通过导管内注射牛磺胆酸钠（3%，1 mL/千克BW）和肠激酶（2 U/千克BW）诱导胰腺炎。我们关注脓毒症的发生、血清细胞因子、主要组织相容性复合体II（MHC II）下调和内毒素受体CD14表达、细菌移位/内毒素血症以及肺和肾组织学改变。
CVVH延迟或明确预防了脓毒症的发生。胰腺炎与脓毒症后期接近基线水平之前巨大的初始肿瘤坏死因子-α（TNF-α）反应相关。终末期脓毒症中TNF-α水平下降与内毒素血症增加的分离所提示的数据，CVVH对内毒素低反应性有有利影响。在非脓毒症动物中，MHC II和CD14表达的下调得到预防。CVVH相关的脓毒症保护导致肺和肾组织学损伤显著减轻。“预防性”CVVH比“晚期”CVVH更有效地预防了组织学变化。
CVVH为重症胰腺炎的支持治疗提供了一种治疗选择。CVVH的疗效与滤器使用时间和累积血浆周转率相关。由于CVVH可能导致脓毒症保护和长期生存，因此有必要在对照临床试验中进行进一步评估。
