Heidemann S M, Ofenstein J P, Sarnaik A P
Department of Pediatric, Children's Hospital of Michigan, Detroit 48201, USA.
Circ Shock. 1994 Dec;44(4):183-7.
We determined the efficacy of continuous arteriovenous hemofiltration (CAVH) in removing tumor necrosis factor (TNF), thromboxane A2, and prostacyclin, and in improving survival in endotoxemia. Twelve rats were given 10 mg/kg of E. coli 0:127:B8 lipopolysaccharide. Fifteen min later, the rats were randomized to ultrafiltered or non-ultrafiltered groups. Blood and ultrafiltrate were collected for TNF, thromboxane B2 (TxB2), and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). After 4 hr, surviving rats were sacrificed. Five of 6 ultrafiltered and none of 6 non-ultrafiltered rats survived 4 hr. Plasma TxB2 > 1,000 pcg/ml and its rate of increase within the first 2 hr predicted death (P < 0.03). Ultrafiltration decreased the rate of rise in TxB2 (P < 0.04). Plasma TxB2 inversely correlated with TxB2 clearance by ultrafiltration. The concentration and rate of increase in TNF and 6-keto-PGF1 alpha did not predict survival. We conclude that CAVH improves short term survival in endotoxemia. Salutary effects appear to be due to thromboxane A2 removal.
我们测定了持续动静脉血液滤过（CAVH）在清除肿瘤坏死因子（TNF）、血栓素A2和前列环素以及改善内毒素血症大鼠存活率方面的疗效。给12只大鼠注射10mg/kg的大肠杆菌0:127:B8脂多糖。15分钟后，将大鼠随机分为超滤组和非超滤组。采集血液和超滤液，检测其中的TNF、血栓素B2（TxB2）和6-酮-前列腺素F1α（6-酮-PGF1α）。4小时后，处死存活的大鼠。超滤组6只大鼠中有5只存活4小时，非超滤组6只大鼠均未存活4小时。血浆TxB2>1000pg/ml且其在最初2小时内的升高速率可预测死亡（P<0.03）。超滤降低了TxB2的升高速率（P<0.04）。血浆TxB2与超滤清除TxB2的速率呈负相关。TNF和6-酮-PGF1α的浓度及升高速率不能预测存活率。我们得出结论，CAVH可改善内毒素血症大鼠的短期存活率。有益作用似乎是由于血栓素A2的清除。
