摘要目的 探讨连续性静脉-静脉血液滤过(CVVH)对全身炎症反应综合征(SIRS)患者Alb代谢率的影响.方法 回顾性分析2010年12月至2011年12月南京军区南京总医院收治的28例SIRS患者的临床资料.其中8例患者仅常规抗感染、对症治疗(对照组);10例患者行血液滤过治疗,血液滤过置换量为2 000 mL/h(低容量组);10例患者行血液滤过治疗,血液滤过置换量为4 000 mL/h(高容量组).采用稳定性同位素示踪技术,向患者同时静脉输注两种稳定性同位素标记的苯丙氨酸:[1-13C]苯丙氨酸和d5-苯丙氨酸.采用气相色谱质谱联用仪的选择离子检测模式检测质荷比为192、194、197、218和219片段的峰面积.采用数学模型计算Alb合成率(FSR)和分解率(FBR).多组比较采用单因素方差分析,组间比较采用LSD或Dunnett's T3检验.结果 对照组、低容量组和高容量组患者治疗前Alb FSR分别为5.8％±0.9％、5.7％±1.1％、5.7％±1.0％,3组比较,差异无统计学意义(F=0.04,P＞0.05);治疗后Alb FSR分别为5.9％±0.8％、7.3％±0.9％、7.8％±1.1％,3组比较,差异有统计学意义(F=9.15,P＜0.05).治疗后低容量组和高容量组患者Alb FSR均显著高于对照组患者(=3.40,3.96,P＜0.05);低容量组和高容量组患者Alb FSR比较,差异无统计学意义(t=1.02,P＞0.05).对照组、低容量组和高容量组患者治疗前Alb FBR分别为7.0％±1.2％、6.5％±0.9％、7.2％±1.2％,3组比较,差异无统计学意义(F =0.88,P＞0.05);治疗后3组患者Alb FBR分别为6.9％±1.1％、6.2％±0.9％、7.4％±1.0％,3组比较,差异无统计学意义(F=2.82,P＞0.05).结论 CVVH可调节SIRS患者蛋白代谢,能够提高Alb FSR,但不能降低Alb FBR.

abstractsObjective To investigate the effects of continuous veno-venous hemofiltration (CVVH) on albumin metabolism of patients with systemic inflammatory response syndrome (SIRS).Methods The clinical data of 28 patients who were admitted to the Nanjing General Hospital of Nanjing Military Command from December 2010 to Decemer 2011 were retrospectively analyzed.All the patients were divided into the control group (8 patients),the low-volume CVVH group (2 000 ml/h,10 patients),and the high-volume CVVH group (4 000 mL/h,10 patients).Two stable isotopes,[1-13C] phenylalanine and d5-phenylalanine,were simultaneously intravenously infused into all the patients.The peak areas were calculated for segments with the mass to charge ratios of 192,194,197,218,219 by the selected ion mode of the gas chromatography mass spectrometry.The fractional synthesis rate (FSR) and the fractional breakdown rate (FBR) of albumin were calculated by the mathematical model.All data were analyzed using the one-way analysis of variance,LSD test or Dunnett's T3 test.Results The FSRs of albumin were 5.8％±0.9％,5.7％ ± 1.1％ and 5.7％ ± 1.0％ in the control group,the low-volume CVVH group and the high-volume CVVH group before treatment,with no significant difference between the 3 groups (F =0.04,P＞0.05).The FSRs of albumin were 5.9％±0.8％,7.3％±0.9％ and 7.8％± 1.1％ in the control group,the low-volume CVVH group and the high-volume CVVH group after treatment,with significant difference between the 3 groups (F =9.15,P ＜0.05).The FSRs of albumin of the low-volume CVVH group and the highvolume CVVH group were significantly higher than that of the control group (t =3.40,3.96,P ＜ 0.05),while no significant difference was detected between the low-volume CVVH group and the high-volume CVVH group in the FSR of albumin (t =1.02,P ＞ 0.05).The FBRs of albumin were 7.0％ ± 1.2％,6.5％ ± 0.9％ and 7.2％ ±1.2％ in the control group,the low-volume CVVH group and the high-volume CVVH group before treatment,with no significant difference between the 3 groups (F =0.88,P ＞ 0.05).The FBRs of albumin were 6.9％ ± 1.1％,6.2％±0.9％ and 7.4％± 1.0％ in the control group,the low-volume CVVH group and the high-volume CVVH group after treatment.There was no significant difference in the FBR of albumin after treatment between the 3 groups (F =2.82,P ＞ 0.05).Conclusions Simultaneous infusion of multiple isotopes for the detection of FSR and FBR of albumin is effective and feasible to detect the albumin metabolism.CVVH regulates the albumin metabolism in SIRS patients,and it can increase FSR of albumin in SIRS patients,while the FBR of albumin cannot be decreased by CVVH.