BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsor...BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.展开更多
Background Many studies have shown that continuous renal replacement therapy （CRRT） could clean lactate and treat the hyper-lactatemia.On the contrary,some other studies found that filter lactate clearance only acco...Background Many studies have shown that continuous renal replacement therapy （CRRT） could clean lactate and treat the hyper-lactatemia.On the contrary,some other studies found that filter lactate clearance only accounted for a very small part of total lactate clearance and the hemofilter＇s contribution to the overall lactate clearance was negligible.The objective of this study was to evaluate the effects of various doses of continuous veno-venous hemofiltration （CWH） on plasma lactate elimination in critically ill patients.Methods Patients were divided into three groups according to their incipient plasma lactate concentration.Group A：lactate≤2 mmol/L,group B：lactate 2-5 mmol/L,group C：lactate ≥5 mmol/L.Three different doses （20 ml.kg-1.h-1,35ml·kg-1·h-1 and 45 ml.kg1.h-1） of CWH were applied to critically ill patients who experiencing CWH.The concentrations of plasma lactate in pre-（A）,post-dialyzer （V） sites and ultrafiltrate were measured after each dosage of CWH was carried out for 30 minutes.Rate of lactate clearance by the filter （RLC） and filter lactate clearance （FLC） and Lactate-Sieving Coefficient （LSC） were calculated under different circumstances,including different doses of CWH and different incipient lactate levels.Results Fifteen patients were enrolled and 104 blood samples were drawn and lactate concentrations were measured in this study.RLC was found increased （（9.36±9.73） mmol/h,（13.92±12.56） mmol/h and （16.52±12.71） mmol/h,P ＜0.05respectively） with the dose of CWH increased.RLC was also increased （（3.46±1.46）,（10.38±5.50） and （24.53±14.69） mmol/h,P ＜0.05 respectively） with the incipient lactate increased.FLC was increased （（1.95±0.63）,（2.95±0.74） and （3.45±0.54） L/h,P ＜0.05 respectively） with the dose of CVVH increased.There was no significant difference of LSC in different doses of CWH and different incipient lactate levels.Conclusions Plasma lactate can be eliminated by CWH and different doses of CWH affect the rate of lactate clearance in critically ill patients.展开更多
AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal ...AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study. RESULTS: Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs116.3±7.8 kPa,P＜0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio. CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.展开更多
AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk datab...AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.展开更多
Continuous arterovenous hemifiltration (CAVH) is an effective and safe method which can remove excess water and solute in the body for treating acute and chronic renal failure with hypervolemia and heart failure. In t...Continuous arterovenous hemifiltration (CAVH) is an effective and safe method which can remove excess water and solute in the body for treating acute and chronic renal failure with hypervolemia and heart failure. In this paper the nursing management of CAVH in 15 patients is discussed.The important points in CAVH nursing are as follows:Select hemofilter of high quality, observe closely the working condition of hemofilter and its tubes, prevent coagulation of blood in the tube, warm the back-infused blood to 30℃, monitor the dosage of heparin and control fluid intake and the diet.展开更多
Objective:To observe the effect of continuous hemofiltration combined with norepinephrine in the treatment of septic shock,and to explore the value of blood purification in the treatment of septic shock.Methods:From N...Objective:To observe the effect of continuous hemofiltration combined with norepinephrine in the treatment of septic shock,and to explore the value of blood purification in the treatment of septic shock.Methods:From November 2018 to December 2020,100 patients with septic shock in the Intensive care unit of our hospital were selected and randomly divided into observation group and control group,with 50 cases in each group.The control group was given conventional treatment,while the observation group was given continuous hemofiltration combined with norepinephrine intervention.The clinical efficacy,Scv02,MAP and oxygenation index(PO_(2)/FiO_(2))of the two groups were compared.The levels of interleukin-6(IL-6),procalcitonin(PCT)and the total number of leukocytes and other inflammatory factors were compared 72 hours after treatment,and the 28-day mortality of the two groups was counted.Results:The total effective rate of the observation group(92.00%)was significantly higher than that of the control group(86.00%),the difference was statistically significant(p<0.05);the 28-day mortality of the two groups was 8.00%in the observation group and 14.00%in the control group,the difference was statistically significant(χ^(2)=4.629,p=0.038);Before treatment,the Scv02,MAP and PO_(2)/FiO_(2)levels of the two groups were significantly higher than those of post-therapy.There was no significant difference between the two groups(p>0.05);After 48 hours of treatment,the levels of Scv02,MAP and PO_(2)/FiO_(2)in the two groups were significantly increased,while the levels of scv02,map,PO_(2)/FiO_(2)in the observation group were more significantly increased than those in the control group(p<0.05);Before treatment,the levels of IL-6,PCT and total white blood cells in the two groups were significantly higher than those of post-therapy(p<0.05)After 72 hours of treatment,the levels of IL-6,PCT and the total number of white blood cells in the two groups decreased significantly,while the levels of IL-6,PCT and the total number of white blood cells in the observation group decreased more significantly than those in the control group(p<0.05).Conclusion:Continuous blood purification combined with norepinephrine can effectively reduce the level of serum inflammatory factors in patients with septic shock,improve hemodynamic indexes,improve survival rate,which is worthy of clinical application.展开更多
文摘BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.
基金Thisstudy was supported by grant from the National Natural Science Foundation of China （No. 81071536）, and Youth Fund of the National Natural Science Foundation of China （No. 81201452）.
文摘Background Many studies have shown that continuous renal replacement therapy （CRRT） could clean lactate and treat the hyper-lactatemia.On the contrary,some other studies found that filter lactate clearance only accounted for a very small part of total lactate clearance and the hemofilter＇s contribution to the overall lactate clearance was negligible.The objective of this study was to evaluate the effects of various doses of continuous veno-venous hemofiltration （CWH） on plasma lactate elimination in critically ill patients.Methods Patients were divided into three groups according to their incipient plasma lactate concentration.Group A：lactate≤2 mmol/L,group B：lactate 2-5 mmol/L,group C：lactate ≥5 mmol/L.Three different doses （20 ml.kg-1.h-1,35ml·kg-1·h-1 and 45 ml.kg1.h-1） of CWH were applied to critically ill patients who experiencing CWH.The concentrations of plasma lactate in pre-（A）,post-dialyzer （V） sites and ultrafiltrate were measured after each dosage of CWH was carried out for 30 minutes.Rate of lactate clearance by the filter （RLC） and filter lactate clearance （FLC） and Lactate-Sieving Coefficient （LSC） were calculated under different circumstances,including different doses of CWH and different incipient lactate levels.Results Fifteen patients were enrolled and 104 blood samples were drawn and lactate concentrations were measured in this study.RLC was found increased （（9.36±9.73） mmol/h,（13.92±12.56） mmol/h and （16.52±12.71） mmol/h,P ＜0.05respectively） with the dose of CWH increased.RLC was also increased （（3.46±1.46）,（10.38±5.50） and （24.53±14.69） mmol/h,P ＜0.05 respectively） with the incipient lactate increased.FLC was increased （（1.95±0.63）,（2.95±0.74） and （3.45±0.54） L/h,P ＜0.05 respectively） with the dose of CVVH increased.There was no significant difference of LSC in different doses of CWH and different incipient lactate levels.Conclusions Plasma lactate can be eliminated by CWH and different doses of CWH affect the rate of lactate clearance in critically ill patients.
基金Supported by the Social Development Foundation of Jiangsu Province, No.BS2000051
文摘AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study. RESULTS: Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs116.3±7.8 kPa,P＜0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio. CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.
基金Supported by The National Natural Science Foundation of China, No.30500684 and Clinical Research Foundation for Residency Granted by the Cooperative Project of West China Hospital and Daiichi Pharmaceutical Co. Ltd., the level Ⅰ
文摘AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.
文摘Continuous arterovenous hemifiltration (CAVH) is an effective and safe method which can remove excess water and solute in the body for treating acute and chronic renal failure with hypervolemia and heart failure. In this paper the nursing management of CAVH in 15 patients is discussed.The important points in CAVH nursing are as follows:Select hemofilter of high quality, observe closely the working condition of hemofilter and its tubes, prevent coagulation of blood in the tube, warm the back-infused blood to 30℃, monitor the dosage of heparin and control fluid intake and the diet.
基金by Scientific research project plan of Weifang Health Committee(Grant No:wfwsjk2019076).
文摘Objective:To observe the effect of continuous hemofiltration combined with norepinephrine in the treatment of septic shock,and to explore the value of blood purification in the treatment of septic shock.Methods:From November 2018 to December 2020,100 patients with septic shock in the Intensive care unit of our hospital were selected and randomly divided into observation group and control group,with 50 cases in each group.The control group was given conventional treatment,while the observation group was given continuous hemofiltration combined with norepinephrine intervention.The clinical efficacy,Scv02,MAP and oxygenation index(PO_(2)/FiO_(2))of the two groups were compared.The levels of interleukin-6(IL-6),procalcitonin(PCT)and the total number of leukocytes and other inflammatory factors were compared 72 hours after treatment,and the 28-day mortality of the two groups was counted.Results:The total effective rate of the observation group(92.00%)was significantly higher than that of the control group(86.00%),the difference was statistically significant(p<0.05);the 28-day mortality of the two groups was 8.00%in the observation group and 14.00%in the control group,the difference was statistically significant(χ^(2)=4.629,p=0.038);Before treatment,the Scv02,MAP and PO_(2)/FiO_(2)levels of the two groups were significantly higher than those of post-therapy.There was no significant difference between the two groups(p>0.05);After 48 hours of treatment,the levels of Scv02,MAP and PO_(2)/FiO_(2)in the two groups were significantly increased,while the levels of scv02,map,PO_(2)/FiO_(2)in the observation group were more significantly increased than those in the control group(p<0.05);Before treatment,the levels of IL-6,PCT and total white blood cells in the two groups were significantly higher than those of post-therapy(p<0.05)After 72 hours of treatment,the levels of IL-6,PCT and the total number of white blood cells in the two groups decreased significantly,while the levels of IL-6,PCT and the total number of white blood cells in the observation group decreased more significantly than those in the control group(p<0.05).Conclusion:Continuous blood purification combined with norepinephrine can effectively reduce the level of serum inflammatory factors in patients with septic shock,improve hemodynamic indexes,improve survival rate,which is worthy of clinical application.
