Background Traumatic brain injury (TBI) is one of the most frequent and severe neurological diseases. In the last few decades, significant advances have been made in TBI pathophysiology and monitoring, however new treatments have not emerged. Although the central nervous system (CNS) has been historically defined as an immunologically privileged organ, recent studies show the increasingly predominant role of inflammatory and apoptotic phenomena in the pathogenesis of TBI. Inflammatory response mediators can be eliminated with continuous renal replacement therapies (CRRT). Our aim was to investigate whether hemofiltration protects the brain after head trauma in an experimental study in animals. Methods and results A model of TBI and CVVH was performed in anesthetized New Zealand white rabbits without acute renal failure. The experimental group TBI ( +)-CVVH ( +) was compared with a TBI ( +)-CVVH (−) and a TBI (−)-CVVH ( +) control groups. Rabbits were assessed immediately (NES1) and 24 h hours after (NES2) TBI and/or CVVH using a functional Neurological Evaluation Score (NES) and histology of the brains after sacrifice. There was evidence to support a difference of NES1 comparing with the TBI (−)-CVVH ( +), but not with TBI ( +)-CVVH (−) with only 15% of the rabbits treated with CVVH and TBI showing a favorable neurological course. The final neurological outcome (mortality at 24 h) was 0%, 22% and 53% in the TBI(−) + CVVH( +), TBI( +)-CVVH(−) and TBI( +)-CVVH( +) groups respectively. The use of hemofiltration before or after TBI did not make a difference in regards the outcome of the rabbits. There was evidence in the histology to support an increase of mild ischemia, hemorrhage and edema in the experimental group compared with the other two groups. Conclusions CVVH in rabbits without renal failure used with the intention to protect the brain may worsen the prognosis in TBI.

中文翻译：

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头部外伤后血液滤过能保护大脑吗？兔子的实验研究

背景创伤性脑损伤（TBI）是最常见和最严重的神经系统疾病之一。在过去的几十年中，TBI 的病理生理学和监测取得了重大进展，但尚未出现新的治疗方法。尽管中枢神经系统 (CNS) 在历史上一直被定义为具有免疫学特权的器官，但最近的研究表明，炎症和凋亡现象在 TBI 的发病机制中发挥着越来越重要的作用。炎症反应介质可以通过连续肾脏替代疗法 (CRRT) 消除。我们的目的是通过动物实验研究血液滤过是否能保护头部外伤后的大脑。方法和结果 在没有急性肾功能衰竭的麻醉新西兰白兔中建立了 TBI 和 CVVH 模型。实验组TBI(+)-CVVH(+)与TBI(+)-CVVH(-)和TBI(-)-CVVH(+)对照组进行比较。使用功能性神经学评估评分 (NES) 和处死后大脑的组织学对兔子进行立即 (NES1) 和 (NES2) TBI 和/或 CVVH 后 24 小时评估。有证据支持 NES1 与 TBI (-)-CVVH (+) 相比存在差异，但与 TBI (+)-CVVH (-) 相比不存在差异，只有 15% 的兔子接受 CVVH 和 TBI 治疗后显示出良好的神经功能课程。TBI(-) + CVVH( +)、TBI( +)-CVVH(-) 和 TBI( +)-CVVH( +) 的最终神经学结果（24 小时死亡率）分别为 0%、22% 和 53%组分别。在 TBI 之前或之后使用血液滤过对兔子的结果没有影响。组织学中有证据支持与其他两组相比，实验组的轻度缺血、出血和水肿增加。结论 无肾功能衰竭家兔 CVVH 用于保护大脑可能会恶化 TBI 的预后。