目的通过析因设计探讨血液滤过中肿瘤坏死因子α(tumor necrosis factor-α,TNF-a)筛选系数的影响因素。方法48 例严重脓毒症患者随机分为8 组，每组6 人行连续性静脉静脉血液滤过(continuous veno venous hemofiltration,CVVH)治疗，将CVVH 的超滤速度[30ml/(kg·h)、70ml/(kg·h)]、血浆流量(100ml/min,180ml/min)和治疗时间(6h,12h)作为影响因素，按2×2×2 析因设计分为8 组，评介其对TNF-a 筛选系数的影响。结果超滤速度、治疗时间对TNF-a 筛选系数有交互作用(P=0.001), 在超滤速度为30ml/h、治疗时间为6h 的组中TNF-a 筛选系数最高(0.162±0.002)；超滤速度30ml/(kg·h)与70ml/(kg·h)相比、治疗时间6h 与12h 相比，TNF-a 筛选系数增加(P＜0.001)；血浆流量100ml/min 与180ml/min 相比,TNF-a 筛选系数下降(P＜0.001)。结论超滤速度、治疗时间对TNF-a筛选系数有交互作用；增加超滤速度和延长治疗时间，TNF-a 筛选系数下降；增加血浆流量可提高TNF-a筛选系数。

Objective To investigate the factors to influence tumor necrosis factor α (TNF-α) sieving coefficient in continuous veno-venous hemofiltration (CVVH) analyzed by factorial design. Method A total of 48 patients with severe sepsis were randomly divided into 8 groups (6 patients in each group). CVVH ultrafiltration rate was set at 30ml/(kg· h) or 70ml/(kg· h), plasma flow at 100ml/min or 180ml/min, and treatment time at 6h or 12h. The patients were then divided into 8 groups according to the 2×2×2 factorial design to evaluate the impacts of the three factors on TNF-α sieving coefficient. Results Ultrafiltration rate and treatment time had interacted effect on TNF-α sieving coefficient (P=0.001). TNF-α sieving coefficient was the highest in the group with ultrafiltration rate of 30ml/h and treatment time of 6h (0.162±0.002). TNF-α sieving coefficient increased in ultrafiltration rate of 30ml/kg.h as compared to that of 70ml/(kg· h), and in treatment time of 6h as compared to that of 12h (P＜0.001). TNF-α sieving coefficient decreased in plasma flow of 100ml/min as compared to that of 180ml/min (P 0.001). Conclusion Ultrafiltration rate and treatment time have interacted effect on TNF-α sieving coefficient. TNF-α sieving coefficient becomes decreased when ultrafiltration rate increases and treatment time is prolonged. TNF-α sieving coefficient becomes increased when plasma flow rises.