Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome

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.

Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

BACKGROUND Polymyxin B hemoperfusion(PMX-HP)has been used as a treatment for intraabdominal septic shock by absorbing and removing endotoxins of gram-negative bacilli.AIM To investigate the clinical efficacy of PMX-HP in patients with gram-negative septic shock who underwent abdominal surgery.METHODS From January 2012 to December 2018,patients who had septic shock secondary to peritonitis were enrolled.They were classified into PMX-HP treated and control groups based on postopreative intervention using PMX-HP.The clinical outcomes were compared using 1:1 propensity score matching methods to balance the overall distribution between the two groups.RESULTS After propensity score matching,40 patients were analyzed(20 patients in the PMX group and 20 patients in the control group).The scores of total Sequential Organ Failure Assessment(SOFA)score,renal SOFA and coagulation SOFA were significantly improved in the PMX group but not in the control group.(from 11.2±5.8 to 4.7±3.5 in PMX group vs 10.0±4.0 to 8.7±7.3 in control group,P=0.047 from 2.6±1.0 to 0.7±1.0 in PMX group vs 2.6±1.5 to 2.8±1.6 in control group,P=0.000,from 1.6±1.5 to 1.3±1.3 in PMX group vs 1.2±1.2 to 2.8±1.8 in control group,P=0.014,respectively).Further,the length of intensive care unit(ICU)stay was significantly shorter in PMX group.However,no statistically significant difference was found in ICU mortality(50%in PMX group vs 50%in control group).CONCLUSION PMX-HP is a feasible adjunct treatment for peritonitis in ICU patients with peritonitis for improved organ impairment and to stabilize hemodynamics.It would be helpful to enhance clinical outcomes especially in patients with complete elimination of the source of gram-negative bacilli infection by surgical procedure accompanied with conventional treatment of sepsis.

Effect of hemoperfusion cartridge on different internal environmental indicators

BACKGROUND:This study aimed to observe the effect of hemoperfusion(HP) cartridge on different internal environment indicators at different time points in patients with acute blood poisoning and to find alternative indicators for the detection of blood poisoning.METHODS:The levels of internal environment indicators(blood pH,P_vCO_2,P_vCO_2,blood lactate,potassium,free calcium,bicarbonate,and blood glucose) before and after HP treatment were recorded for patients with acute poisoning at time points of 30 minutes and 120 minutes.After calculating the difference value 5,the statistical software was used to analyze the statistical difference of the influence caused by HP cartridge at two time points.According to the formula,adsorption rate%=(a-v)/a×100,the adsorption rate of each indicator was calculated respectively.RESULTS:The difference of indicators at different time points in inlet and outlet such as blood glucose,free-calcium,and lactate was statistically significant(P<0.05),but the difference in indicators such as pH,P_vCO_2,P_vO_2,potassium,sodium,and bicarbonate was not statistically significant(P>0.05).CONCLUSION:During HP treatment,the indicators of blood glucose,free-calcium and lactate were significantly affected by HP cartridge,and the effect varies with time.

Effect of hemodialysis combined with hemoperfusion on dialysis efficiency, lipid metabolism and atherosclerosis in patients with uremia

Objective:To study the effect of hemodialysis (HD) combined with hemoperfusion (HP) on dialysis efficiency, lipid metabolism and atherosclerosis in patients with uremia.Methods:A total of 70 patients with uremia who were treated in our hospital between March 2013 and October 2015 were collected and divided into observation group and control group (n=35) according to double-blind randomized control method. Observation group of patients received hemodialysis combined with hemoperfusion, control group of patients received hemodialysis alone, and the treatment lasted for 6 months. After 6 months of intervention, automatic biochemical analyzer was used to detect renal function indexes and lipid metabolism indexes, and the two-dimensional ultrasound was used to quantitatively determine the carotid atherosclerosis parameters.Results:Before intervention, differences in renal function, lipid metabolism and atherosclerosis levels were not statistically significant between two groups of patients;after 6 months of intervention, renal function indexes blood urea nitrogen (BUN), serum creatinine (Scr),β2-microglobulin (β2-MG) and blood uric acid (BUA) levels of observation group were lower than those of control group, lipid metabolism indexes total cholesterol (TC), triglyceride (TG), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) levels were lower than those of control group, and differences between groups were statistically significant;quantitative carotid ultrasound parameters gray-scale median (GSM) of observation group was higher than that of control group, enhanced intensity (EI) and enhanced density (ED) were lower than those of control group, and differences between groups were statistically significant.Conclusion:Hemodialysis combined with hemoperfusion can improve the dialysis efficiency, also reduce lipid metabolism disturbance and delay the formation of atherosclerosis in patients with uremia.

Direct hemoperfusion with a polymyxin B-immobilized cartridge in intestinal warm ischemia reperfusion

AIM: To investigate the effectiveness of direct hemo- perfusion with polymyxin B-immobilized fibers (DHP- PMX therapy) on warm ischemia-reperfusion (I/R) injury of the small intestine. METHODS: The proximal jejunum and distal ileum of mongrel dogs were resected. Warm ischemia was performed by clamping the superior mesenteric artery (SMA) and vein (SMV) for 2 h. Blood flow to the proximal small intestine was restored 1 h after reperfusion, and the distal small intestine was used as a stoma. The experiment was discontinued 6 h after reperfusion. The dogs were divided into two groups: the DHP-PMX group (n = 6, DHP-PMX was performed for 180 min; from 10 min prior to reperfusion to 170 min after reperfusion) and the control group (n = 5). The rate pressure product (RPP), SMA blood flow, mucosal tissue blood flow, and intramucosal pH (pHi) were compared between the two groups. The serum interleukin (IL)-10 levels measured 170 min after reperfusion were also compared. RESULTS: The RPP at 6 h after reperfusion was significantly higher in the PMX group than in the control group (12 174 ± 1832 mmHg/min vs 8929 ± 1797 mmHg/min, P < 0.05). The recovery rates ofthe SMA blood flow at 1 and 6 h after reperfusion were significantly better in the PMX group than in the control group (61% ± 7% vs 44% ± 4%, P < 0.05, and 59% ± 5% vs 35% ± 5%, P < 0.05, respectively). The recovery rate of the mucosal tissue blood flow and the pHi levels at 6 h after reperfusion were significantly higher in the PMX group (61% ± 8% vs 31% ± 3%, P < 0.05 and 7.91 ± 0.06 vs 7.69 ± 0.08, P < 0.05, respectively). In addition, the serum IL-10 levels just before DHP-PMX removal were significantly higher in the PMX group than in the control group (1 569 ± 253 pg/mL vs 211 ± 40 pg/mL, P < 0.05). CONCLUSION: DHP-PMX therapy reduced warm I/R injury of the small intestine. IL-10 may play a role in inhibiting I/R injury during DHP-PMX therapy.

Microencapsulated Hepatocytes Hemoperfusion for the Treatment of Fulminant Hepatic Failure Rats

Hepatocytes were isolated from suckling porcine using modified seglen’s collagenase perfusion technique, and were encapsulated with alginate-polylysine-alginate (APA) microcapsules. Fulminant hepatic failure(FHF) was induced in male SD rats by galactosamine. Hemoperfusion performed 24hErs after galactosamine injection. In vitro culture, both encapsulated hepatocytes and free hepatocytes express the ability to synthesis Albumin, Urea .for 7 days, Encapsulated hepatocytesperfusied with Williams’ E medium was shown to provide albumin, urea synthesis functions in 24hrs. The survival time after treatment of microencapsulated hepatocytes hemoperfusion group was longer than othergroups, and Serum ALT, TBIL levels decreased.

Effects of hemoperfusion combined with sequential dialysis on soluble tumor necrosis factor receptor in patients with diabetic kidney disease

Objective: To observe the effects of hemoperfusion combined with sequential dialysis on soluble tumor necrosis factor receptor in patients with diabetic kidney disease. Methods:A total of 100 patients with diabetic kidney disease who had been seeking treatment in the hospital between May 2015 and July 2017 were selected, and then according to the random number table method, these patients were divided into a control group and an observation group, with 50 cases in each group. The control group was treated with hemodialysis only, whereas the observation group was given hemoperfusion combined with sequential dialysis for treatment. The changes of soluble tumor necrosis factor receptor, oxidant factor and metabolic indexes after 12 weeks of treatment were compared between the two groups. Results: After treatment, the metabolic indexes in the observation group were shown to be lower than the control group, the levels of soluble tumor necrosis factor receptor related indexes in the former group were lower than the control group, and the level of oxidative stress indicators in the former group was shown to be better than the control group, where the differences were statistically significant. Conclusion: For patients with diabetic kidney disease, hemoperfusion combined with sequential dialysis is with significant clinical curative effects, which can effectively relieve their oxidative stress, better control the blood glucose level, significantly improve their renal function and significantly reduce the level of soluble tumor necrosis factor receptor.

STRUCTURAL AND ADSORPTION RELATIONSHIP OF MACROPOROUS R ESIN IN HEMOPERFUSION

In order to achieve high adsorption capacity of adsorbents in hemoperfusion,macroporous resins were tailor made with appropriate pore sizes and specific area. This allows the toxin molecules to diffuse freely within the channels ofthe porous resins and rinally reach the adsorption sites.Macroporous resin NK - 107 having small pore size and large Surface area(1086cm2) were synthesized which showed a high adsorption capacity of 82 - 94%for small molecules such as hypnotic and sedative drugs. For the adsorption of middle molecules i. e. Vit B12 or cytochrome C adsorbents having large pore sizes weretailor made. In the case of the adsorption of unconjugated bilirubin which is a verybig molecule, the pore size of the adsorbent should be at least>160A. NK - 110 istailor made with a very big pore size,which have a high adsorption capacity of 87%for bilirubin. DNA immobilized on carbonized resins,which have a porous structurewith a large surface area of 1000m2/g,can adsorb DNA antibody effectively. Resultsfrom animal and clinical trials indicated that the above tailor - made adsorbentshave a high efficacy in the removal of endogenous and exogenous toxins in hemoperfusion.

Effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning

Objective: To investigate the effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning. Methods: A total of 42 patients with acute paraquat poisoning who were admitted and treated in our hospital between December 2013 and October 2017 were selected as the research subjects, and their therapies were reviewed and used to divide them into the control group (n=20) who received hemoperfusion alone and the combined treatment group (n=22) who received hemoperfusion combined with hemodialysis. The differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were compared between the two groups of patients immediately after admission, after 1 d of treatment and after 3 d of treatment. Results: Immediately after admission, the differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were not statistically significant between the two groups. After 1d of treatment and after 3 d of treatment, kidney function indexes Scr, BUN and β2-MG levels in peripheral blood of combined treatment group were lower than those of control group at corresponding time points respectively;liver function indexes ALT, AST, TB and ALP levels in peripheral blood were lower than those of control group at corresponding time points respectively;lung function indexes PaO2, BE and PCO3- levels in arterial blood were higher than those of control group at corresponding time points respectively whereas PaCO2 levels were lower than those of control group at corresponding time points respectively. Conclusion: Compared with hemoperfusion alone, hemoperfusion combined with hemodialysis is more advantageous in protecting the functions of liver, kidney, lungs and other target organs of patients with acute paraquat poisoning.

Effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning and influence of it on cholinesterase, dopamine and inflammatory factors

Objective:To investigate effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning (AOPP) and influence of it on cholinesterase, dopamine and inflammatory factors.Methods:A total of 82 cases of AOPP patients treated in our hospital from Sep 2012 to Jul 2016 were selected as subjects. They were randomly divided to be the observation group and the control group, 41 cases for each. For patients in observation group, combined therapy of hemoperfusion (HP) and hemofiltration (HF) were provided. For patients in control group, combined therapy of HP and hemodialysis (HD) were provided. Effects on the two groups of patients were compared. Meanwhile, cholinesterase, dopamine and inflammatory factors levels in different times before and after treatment were compared.Results:Consciousness improvement times and hospitalization times in observation group were significantly lower than in control group. No significant difference showed on fatality rates between the two groups. Before treatment, no significant difference showed on CHE and DE levels between two groups of patients;6 h and 12 h after treatment, CHE average levels in two groups were significantly higher than before treatment in the same group, and levels in observation group at the same phase were significantly higher than in control group;6 h and 12 h after treatment, DA levels in observation group were significantly lower than the same group before treatment, and significantly lower than control group, while 12 h after treatment, DA levels in control group were significantly lower than the same group before treatment. Before treatment, no significant difference showed on serum TGF-β1, TNF-α, IL-6, IL-8 between two groups of patients. After treatment, each index levels in two groups were significantly lower than the same group before treatment, and levels in observation group at the same phase were significantly lower than control group. Conclusion:Effects of blood purification therapy on treating AOPP were worth approving, but effects of HP and HF combined therapy were more significant. In addition, improvement of HP+HF on CHE, DA and inflammatory factors were better than HP+HD.

Effects of intensive hemoperfusion on the toxin clearance, target organ function and oxidative stress in patient with paraquat poisoning

Objective: To study the effects of intensive hemoperfusion on the toxin clearance, target organ function and oxidative stress in patient with paraquat poisoning. Methods: A total of 56 patients with paraquat poisoning who were treated in the People's Hospital of Hanchuan between November 2013 and January 2017 were reviewed and divided into the control group (n=30) and the intensive hemoperfusion group (n=26). Control group received conventional therapy, and intensive hemoperfusion group received conventional therapy combined with intensive hemoperfusion. The differences in paraquat clearance effect, target organ function and oxidative stress response were compared between the two groups. Results: Serum paraquat level in intensive hemoperfusion group was lower than that in control group, and the paraquat clearance rate was higher than that of control group. Serum pulmonary fibrosis indexes PⅠCP, CⅣ and HA levels in intensive hemoperfusion group were lower than those in control group;serum liver function indexes ALP, STB and ALT levels were lower than those in control group;serum oxidative stress index GSH-Px level was higher than that in control group whereas MDA level was lower than that in control group. Conclusion: Intensive hemoperfusion can significantly improve the paraquat clearance rate, protect the important organ function and suppress the systemic oxidative stress response in patient with paraquat poisoning.

阿托品联合连续静脉-静脉血液滤过及血液灌流治疗老年急性重症有机磷中毒的临床分析

目的分析老年急性重症有机磷中毒患者接受阿托品联合连续静脉-静脉血液滤过(CVVH)+血液灌流(HP)治疗方案的疗效。方法回顾性选取2019年1月—2022年1月于自贡市第一人民医院救治的老年急性重症有机磷中毒患者64例,根据不同救治方案将患者分为使用阿托品救治的对照组(32例)和使用阿托品联合CVVH+HP方案救治的观察组(32例)。2组均接受反复清洗胃部、甘露醇或硫酸镁导泻、大量吸氧、平衡电解质、应用胆碱酯酶复能剂氯磷定等常规急救措施,此外,对照组使用阿托品救治,观察组使用阿托品联合CVVH+HP方案救治。观察并比较2组恢复情况、胆碱酯酶(ChE)水平、心肝肾等脏器功能损伤程度评估值[心功能指标值:心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB);肝功能指标值:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST);肾功能指标值:尿蛋白定量、尿素氮、血肌酐)];评估并比较2组机体氧化应激程度[人过氧化脂质(LPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平]、局部炎症情况[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、降钙素原(PCT)水平]、不良事件、临床疗效以及缓解期严重并发症发生情况。结果与对照组比较,观察组患者清醒时间、机械通气时间、ChE活性恢复正常时间和住院时间均明显缩短,差异均有统计学意义(P<0.05)。治疗后,2组ChE水平均高于同组治疗前,且观察组ChE水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者CK-MB、cTnI、cTnT、ALT、AST、尿蛋白定量、尿素氮、血肌酐水平均低于同组治疗前,观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者LPO和MDA水平均低于同组治疗前,而SOD水平高于同组治疗前;观察组LPO和MDA水平均低于对照组,而SOD水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者IL-1β、IL-6、PCT水平均低于同组治疗前,且观察组IL-1β、IL-6、PCT水平均低于对照组,差异均有统计学意义(P<0.05)。与对照组比较,观察组治疗不良事件发生率降低,而疗效升高,差异均有统计学意义(P<0.05)。与对照组比较,观察组IMS、反跳等严重并发症发生率降低,但2组差异无统计学意义(P>0.05)。结论阿托品联合CVVH+HP方案可降低老年急性重症有机磷中毒患者相关并发症的发生,促进ChE表达,抑制局部炎症,增强抗氧化能力,减少对脏器功能的损害,疗效较好,具有一定的临床应用价值。

急性肾衰竭血液灌流联合血液透析治疗期间并发低血压的因素分析

目的 分析急性肾衰竭(ARF)血液灌流联合血液透析治疗期间并发低血压的因素。方法 回顾性分析2020年1月—2022年12月于河北省儿童医院接受血液灌流联合血液透析治疗的儿童303例ARF患者临床资料,根据患者3个月内治疗期间有无并发低血压分为并发低血压组(n=61)与未并发低血压组(n=242);采用Logistic回归分析筛选影响ARF血液灌流联合血液透析治疗期间并发低血压的危险因素。结果 303例ARF患者共61例并发低血压(占20.13%)。Logistic回归分析结果显示,高通量透析方式(95%CI 1.196~4.984,P=0.014)、血流量>300 mL/min(95%CI 1.056~4.851,P=0.036)、血红蛋白(95%CI 0.444~0.703,P=0.000)、白蛋白(95%CI 0.153~0.833,P=0.017)均是ARF血液灌流联合血液透析治疗期间并发低血压的重要影响因素(P<0.05)。结论 高通量透析方式、血流量>300 mL/min、血红蛋白、白蛋白均是ARF血液灌流联合血液透析治疗期间并发低血压的重要影响因素。

连续性高容量血液滤过联合血液灌流治疗脓毒症合并急性肾损伤的效果观察

目的:观察连续性高容量血液滤过(CHVHF)联合血液灌流(HP)治疗脓毒症合并急性肾损伤的临床效果。方法:选取2020年1月—2023年6月广西医学科学院·广西壮族自治区人民医院收治的90例脓毒症合并急性肾损伤患者作为研究对象,采用随机数字表法分为新式组与传统组,各45例。两组均接受常规抗脓毒症治疗,传统组在常规抗脓毒症治疗基础上接受CHVHF治疗,新式组在传统组基础上接受HP治疗。比较两组治疗效果。结果:治疗后,两组碱性磷酸酶、肾血流阻力指数水平低于治疗前,且新式组低于传统组,差异有统计学意义(P<0.05)。治疗后,两组彩色多普勒血流成像分级高于治疗前,且新式组高于传统组,差异有统计学意义(P<0.05)。新式组治疗总有效率高于传统组,差异有统计学意义(P<0.001)。治疗后,两组降钙素原、白细胞介素-6、白细胞介素-10、肿瘤坏死因子-α、超敏C反应蛋白水平低于治疗前,且新式组低于传统组,差异有统计学意义(P<0.05)。结论:CHVHF联合HP治疗脓毒症合并急性肾损伤的临床效果显著,可清除血液毒素,改善肾损伤情况及炎性因子水平。

HP+CVVH对重症急性胰腺炎并急性肾损伤患者血管内皮功能、肾小管功能的影响

目的探讨血液灌流(HP)+连续性静脉-静脉血液滤过(CVVH)对重症急性胰腺炎并急性肾损伤患者血管内皮功能、肾小管功能的影响。方法118例重症急性胰腺炎并急性肾损伤患者,按治疗方法的不同分为观察组(68例)和对照组(50例)。对照组应用HP治疗,观察组应用HP+CVVH治疗。比较两组治疗情况、血管内皮功能指标[内皮素-1(ET-1)、血管内皮生长因子(VEGF)及血管性假血友病因子相关抗原(vWF:Ag)]、肾小管功能指标[尿视黄醇结合蛋白(RBP)、尿N-乙酰-β-D氨基葡萄糖苷酶(UNAG)]、血清炎症因子[C反应蛋白(CRP)、白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)]。结果观察组病死率1.47%(1/68)低于对照组的8.00%(4/50),但差异无统计学意义(P>0.05);观察组腹痛消失时间(2.67±0.51)d、腹膜刺激征消失时间(3.14±0.65)d、住院时间(15.41±2.16)d短于对照组的(3.91±0.68)、(4.82±0.71)、(20.82±3.59)d(P<0.05)。治疗后,两组患者ET-1、vWF:Ag、VEGF低于本组治疗前,且观察组ET-1(32.10±3.08)pg/ml、vWF:Ag(121.42±18.75)%、VEGF(134.68±28.79)pg/ml低于对照组的(40.78±3.18)pg/ml、(146.68±20.74)%、(162.47±41.25)pg/ml(P<0.05)。治疗后,两组尿RBP、UNAG水平低于本组治疗前,且观察组尿RBP(0.71±0.46)μg/ml、尿UNAG(1.01±0.52)U/g·Cr低于对照组的(1.62±0.51)μg/ml、(1.46±0.55)U/g·Cr(P<0.05)。治疗后,两组患者血清CRP、TNF-α、IL-2水平低于治疗前,且观察组血清CRP(8.51±1.23)mg/L、TNF-α(2.18±0.45)pg/ml、IL-2(6.53±1.08)pg/ml低于对照组的(13.48±2.58)mg/L、(3.06±0.52)pg/ml、(10.74±1.16)pg/ml(P<0.05)。结论HP+CVVH治疗重症急性胰腺炎并急性肾损伤患者取得较好效果,可改善患者血管内皮功能及肾小管功能,降低机体炎症反应,促进患者尽快恢复,值得应用。

血液灌流治疗在急性重度有机磷中毒患者抢救中的应用效果

目的探讨血液灌流(hemoperfusion,HP)治疗对急性重度有机磷中毒(acute severe organophosphorus poisoning,ASOPP)患者抢救结果及病情恢复时间的影响。方法回顾性分析2021年9月—2023年5月浙江省人民医院毕节医院收治的82例ASOPP患者临床资料,依据治疗方法将患者分为2组,各41例。对照组采用硫酸阿托品注射液联合碘解磷定注射液治疗,观察组在对照组基础上加用HP治疗,2组均连续治疗3 d。对比2组抢救结果、病情恢复时间[意识恢复时间、脱机时间、血清胆碱酯酶(acetylcholinesterase,ACHE)活性恢复时间]、肝肾功能[天冬氨酸转氨酶(glutamic oxaloacetic transaminase,AST)、丙氨酸转氨酶(glutamic pyruvic transaminase,ALT)、血肌酐(serum creatinine,Scr)和尿氮素水平(blood urea nitrogen,BUN)]、神经功能[腓总神经运动传导速度(motor nerve conduction velocity,MCV)、感觉传导速度(sensory nerve conduction velocity,SCV)和F波潜伏期]和并发症(呼吸急促、心律失常、血液病变、低血压)。结果观察组抢救成功率为97.56%,高于对照组的80.49%,差异有统计学意义(P<0.05);观察组患者意识恢复时间为(3.54±1.28)h,脱机时间为(2.72±0.91)d,ACHE活性恢复时间为(4.15±1.12)d,短于对照组的(9.38±1.53)h、(7.09±1.45)d、(6.72±1.69)d,差异有统计学意义(P<0.05);治疗后,观察组AST为(26.13±5.15)U/L,ALT为(25.04±7.62)U/L,Scr为(110.69±20.15)μmol/L,BUN为(7.25±0.58)mmol/L,均低于对照组的(35.16±8.65)U/L、(40.76±10.28)U/L、(174.56±26.47)μmol/L、(9.62±1.08)mmol/L,差异有统计学意义(P<0.05);治疗后,观察组MCV为(48.26±8.32)m/s,SCV为(46.37±8.02)m/s,均高于对照组的(40.06±6.12)m/s、(39.54±6.35)m/s;F波潜伏期为(21.89±2.42)ms,低于对照组的(26.56±3.17)ms,差异有统计学意义(P<0.05);观察组的并发症总发生率为9.09%(3/33),和对照组的15.00%(6/40)比较,差异无统计学意义(P>0.05)。结论应用HP治疗ASOPP患者可提高抢救成功率,缩短病情恢复时间,改善肝肾功能和神经功能,减少并发症的发生。

连续性静脉-静脉血液滤过联合血液灌流治疗急性重度有机磷中毒的临床观察

目的:观察连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)治疗重度有机磷中毒(ASOPP)的临床疗效。方法:回顾性分析126例ASOPP患者资料,根据治疗方式分为CVVH+HP组(n=60)和HP组(n=66)。观察疗效和治疗情况,记录患者治疗前(T1)及治疗后4h(T2)、24h(T3)、72h(T4)时血清胆碱酯酶(CHE)水平,比较两组T1、T3时血清炎症因子[白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]以及对肝肾损伤相关指标[胱抑素(CysC)、前白蛋白(PA)、高迁移率族蛋白B1(HMGB1)]水平差值,观察并发症发生情况。结果:CVVH+HP组痊愈率为93.33%,高于HP组的78.79%(P<0.05);两组反跳发生率差异无统计学意义(P>0.05)。CVVH+HP组阿托品、氯解磷定用量分别为(143.37±18.72)mg、(10.28±2.62)g,少于HP组的(154.18±21.47)mg、(19.57±4.31)(均P<0.05);CVVH+HP组昏迷时间、住院时间分别为(13.38±3.41)h、(7.26±1.58)d,短于HP组的(22.15±4.14)h、(8.42±1.74)d(均P<0.05)。T2~T4时,两组血清CHE水平逐渐升高,且CVVH+HP组升高幅度大于HP组(均P<0.05)。T1时,两组血清IL-1β、IL-6、IL-10、TNF-α水平和血清CysC、PA、HMGB1水平差异无统计学意义(P>0.05);CVVH+HP组血清IL-1β、IL-6、IL-10、TNF-α、CysC、PA、HMGB1的T1-T3差值大于HP组(均P<0.05)。两组并发症发生情况差异无统计学意义(P>0.05)。结论:相较于HP单用,CVVH+HP治疗ASOPP可提升治愈率,改善治疗情况,促进血清CHE活性恢复,减轻炎症反应,缓解脏器损伤,且安全性良好,有一定优势。

连续性肾脏替代治疗联合血液灌流在横纹肌溶解合并急性肾损伤中的研究进展

横纹肌溶解(rhabdomyolysis,RM)是一种多因素造成的骨骼肌损伤及其分解产物释放入血液循环中的临床综合征。急性肾损伤(acute kidney injury,AKI)是横纹肌溶解的常见并发症,主要与肌红蛋白堵塞肾小管及其直接肾毒性作用有关。RM合并AKI的治愈率较低、死亡率较高。既往有研究显示连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)联合血液灌流(hemoperfusion,HP)可以有效治疗RM合并AKI,本文就CRRT联合HP治疗RM合并AKI进行了综述,旨在为临床治疗决策及后续研究提供参考。

血液灌流联合血液滤过对脓毒症炎症介质及预后影响的Meta分析

目的通过Meta分析评价血液灌流联合血液滤过对脓毒症炎症介质及预后的影响。方法检索PubMed、Web of Science、Medline、中国知网(CNKI)、万方数据库、维普数据库,选取血液灌流联合血液滤过对脓毒症治疗的随机对照试验(观察组采用血液灌流联合血液滤过治疗,对照组采用单纯血液滤过治疗),检索时间为建库至2023年6月30日。采用RevMan 5.4软件进行Meta分析,采用漏斗图进行偏倚评估。结果共纳入19篇文献,1322例患者。Meta分析结果显示:观察组与对照组患者相比C反应蛋白降低(SMD=-1.60,95%CI:-2.02~-1.18,P<0.001)、肿瘤坏死因子-α水平下降(SMD=-1.60,95%CI:-1.77~-1.43,P<0.001)、白细胞介素-6水平下降(SMD=-1.29,95%CI:-1.43~-1.14,P<0.001)、序贯器官衰竭评分降低(SMD=-0.74,95%CI:-0.98~-0.51,P<0.001)、病死率降低(RR=0.50,95%CI:0.39~0.65,P<0.001)。结论血液灌流联合血液滤过治疗可以下调脓毒症的炎症介质,降低序贯器官衰竭评分及病死率,改善预后。

血液灌流治疗急性中毒的临床疗效及对并发出血的预防作用

目的探讨血液灌流治疗急性中毒的临床疗效,并分析其对患者并发出血的预防作用。方法选取2020年1月—2023年7月扬州市江都人民医院收治的58例急性中毒患者作为研究对象。采用随机数表法分为两组,对照组(29例)患者接受常规急诊治疗,研究组(29例)接受血液灌流治疗。对比两组患者的疗效,分析肝功能及心肌酶谱指标变化,记录患者昏迷后清醒时间、住院时间、并发出血情况等临床指标。结果研究组总有效率为93.10%,高于对照组的72.41%,差异有统计学意义(P<0.05)。治疗后,两组患者的丙氨酸转氨酶(Alanine Transamination,ALT)、总胆红素(Total Bilirubin,TBiL)、谷氨酰转肽酶(γ-Glutamyltranspeptidase,γ-GT)、乳酸脱氢酶(Lactate Dehydrogenase,LDH)、磷酸肌酸激酶(Creatine Kinase,CK)、肌钙蛋白(Cardiac Troponin T,cTnI)水平均较治疗前降低,且研究组的各项指标均低于对照组,差异有统计学意义(P均<0.05)。研究组出血率(3.45%)低于对照组(20.69%),差异有统计学意义(χ^(2)=4.062,P<0.05)。昏迷后清醒时间及住院时间均短于对照组,差异有统计学意义(P均<0.05)。结论在常规急诊治疗基础上采取血液灌流干预措施,可以提高急性中毒患者的临床疗效,改善肝功能和心肌酶谱,同时减少并发出血事件。