Application of bedside continuous blood purification in patients with multiple organ dysfunction syndromes

BACKGROUND:The complications of systemic inflammatory response syndrome(SIRS)include acute lung injury,acute kidney injury,shock,and multiple organ dysfunction syndrome(MODS).In recent years,how to clear inflammatory mediators has become a hot topic in critical care medicine.Researchers hypothesize that continuous blood purification(CBP) can effectively eliminate a variety of inflammatory mediators which participate in the occurrence of MODS and adjust the immune imbalance.This study aimed to observe the effects of CBP in MODS patients.METHODS:In this retrospective clinical study,a total of 38 MODS patients,18 males and 20 females,were enrolled.After conventional therapy,all the patients received CBP.Biochemistry,blood gas analysis,oxygenation index,mean arterial blood pressure(MAP),acute physiology and chronic health evaluation(APACHE) II scores were monitored.RESULTS:After CBP,the vital signs of patients were rapidly stable,and electrolyte disorders and acid-base imbalance were corrected.Renal function,blood gas,oxygenation index were all improved.MAP was increased,and APACHE II score was significantly decreased.All patients had good tolerance,stable hemodynamics,and no obvious adverse reaction on CBP compared with pre-CBP.CONCLUSION:CBP can effectively clean toxins,correct electrolyte acid-base balance,and improve systemic inflammatory response syndrome and the organ function of MODS patients.

Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis

AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.METHODS: Thirty-one intensive care unit(ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group(n = 15; July 1, 2012 to June 30, 2014) or a control group(n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration(CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 m L/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group(13.33% vs 37.50%; P < 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group(7.4 ± 1.35 d vs 9.19 ± 2.99 d, P < 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group(3.47 ± 0.52 d vs 7.90 ± 1.14 d, P < 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups(60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment(37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P < 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.

Shock index of patients with sepsis after continuous blood purification treatment and its relationship with systemic inflammatory response syndrome and immune response

Objective:To study the shock index of patients with sepsis after continuous blood purification (CBP) treatment and its relationship with systemic inflammatory response syndrome and immune response.Methods:A total of 88 patients with sepsis who underwent continuous blood purification treatment in our hospital between June 2012 and May 2016 were chosen as research subjects, shock index (SI) was compared before and after the treatment, and according to the level of SI after treatment, all patients were divided into shock group (n=27) with SI>0.5 points and no shock group (n=61) with SI≤0.5 points. Serum contents of inflammatory mediators, Th1/Th2 cellular immunity indexes, immunoglobulin and complement were compared between two groups of patients after treatment.Results: The level of SI in patients with sepsis was significantly lower than that before treatment. Serum contents of inflammatory mediators PCT, CRP and HMGB1 in no shock group were lower than those in shock group, contents of Th1 cytokines IL-2 and IFN-γ were higher than those in shock group, contents of Th2 cytokines IL-10 and IL-13 were lower than those in shock group, and contents of IgG, IgM, IgA, C3 and C4 were higher than those in shock group.Conclusion: The level of SI decreases in the patients with sepsis after CBP treatment, and SI level is directly correlated with the systemic inflammatory response syndrome and immune response levels.

Research Progress of Continuous Blood Purification in the Treatment of Severe Sepsis in Children

Pediatric sepsis is the most common disease in pediatric critical illness,because the main reason for the disease is that children's immune level is not high or the immune system is not perfect,when children's lung,abdominal cavity and blood system are infected,it will cause systemic inflammation and immune dysfunction.Early clinical symptoms are mainly irregular and intermittent fever.When the disease develops to severe sepsis,the children will suffer from acute heart failure,oliguria,respiratory alkalosis and even multiple organ failure.The incidence of death is high.It is reported that the incidence rate of sepsis in children can reach 0.3%,and the mortality rate is 50%.High incidence rate,high mortality rate and high treatment cost are the biggest problems in the pediatric field.In the past,the clinical hope of clearing away heat and toxin,promoting blood circulation and removing stasis,strengthening inflammation and other methods in traditional Chinese medicine,but the treatment effect is not ideal.With the improvement of modem medical understanding of sepsis,continuous blood purification therapy is introduced into the treatment of children with severe sepsis.In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis,the author summarizes the clinical practice experience and relevant literature,hoping to provide reference for relevant medical staff。

Effect of continuous blood purification on T lymphocyte subsets and inflammatory response in patients with severe sepsis

Objective:To investigate the effects of continuous blood purification (CBP) on T lymphocyte subsets and inflammatory response in patients with severe sepsis, and to provide scientific evidence for the treatment of severe sepsis patients. Methods:96 cases of severe sepsis patients from June 2013 to June 2016 in Yulin First People's Hospital were as the research subjects, randomly divided into observation group and control group, 48 cases in each group. The control group received routine treatment of sepsis, while the observation group adopted CBP therapy on the basis of the control group, fasting venous blood was collected 7 d before and after treatment respectively, and the change of IL-6, TNF-α, CRP levels, CD3+, CD4+, CD8+lymphocyte percentage and ratio of CD4+/CD8+in two groups were compared before and after treatment in two groups. Results:Before treatment, there were no significant differences in IL-6, TNF-α, and CRP levels between the two groups (P>0.05). After treatment, the IL-6 and TNF-αlevels of observation group and the control group were significantly decreased, CRP level in the observation group decreased significantly, and the IL-6, TNF-αand CRP levels were significantly lower in the observation group than in the control group (P<0.05). Before treatment, there was no statistical difference in the percentage of T cell subsets between the two groups (P<0.05). After treatment, the two groups of patients with CD3+, CD4+, CD8+and CD4+/CD8+were significantly elevated (P<0.05). After treatment, the CD3+, CD4+and CD4+/CD8+were significantly higher in the observation group than in the control group (P<0.05). Conclusions:CBP therapy can effectively reduce the level of inflammatory factors in patients with severe sepsis, reduce the inflammatory response, and can effectively improve the immune function of patients, and the effect is significant.

Effect of continuous blood purification on inflammatory state, immune response and erythrocyte glycometabolism in patients with multiple injury and sepsis

Objective:To analysis the effect of continuous blood purification on inflammatory state, immune response and erythrocyte glycometabolism in patients with multiple injury and sepsis. Methods: A total of 78 patients with multiple injury and sepsis were randomly divided into observation group (n=39) and control group (n=39), control group received routine therapy, observation group received continuous blood purification treatment, and then the differences in inflammatory state, immune response, erythrocyte glycometabolism and other indexes were compared between the two groups after treatment.Results: Inflammatory factor hs-CRP, TNF-α, PCT, sTREM-1 and HBP content in serum of observation group after treatment were significantly lower than those of control group;Th1 cytokines IL-2 and IFN-γ content in serum were lower than those of control group while Th2 cytokines IL-4 and IL-10 content were higher than those of control group;PFK and EGSH content in erythrocyte solution were higher than those of control group while G-6PD, AR and ELPO content were lower than those of control group;fluorescence intensity of CD11a, CD54, CD106 and CD49d in peripheral blood were significantly lower than those of control group.Conclusions: Continuous blood purification can significantly reduce the systemic inflammatory response in patients with multiple injury and sepsis, and promote the immune function and erythrocyte metabolism to return to normal.

Effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis

Objective: To study the effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis. Methods: A total of 78 patients with sepsis who were treated in the hospital between January 2015 and December 2016 were collected and divided into control group and observation group according to the random number table method, 39 cases in each group. Control group received conventional therapy for sepsis, and observation group received continuous blood purification on the basis of conventional therapy. The differences in inflammatory response, immune response and target organ damage were compared between the two groups before and after treatment. Results: Before treatment, difference in serum inflammatory factor contents, peripheral blood Th17/Treg cellular immunity levels and serum myocardial injury marker contents were not statistically significant between the two groups. After treatment, serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral bloodTh17 and Treg cell levels and Th17/Treg proportion of both groups of patients were lower than those before treatment, and serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral blood Th17 and Treg cell levels and Th17/Treg proportion of observation group were lower than those of control group. Conclusion: Continuous blood purification can effectively reduce systemic inflammatory response, inhibit immune response, and reduce myocardial injury in patients with sepsis.

Influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis complicated by MODS

Objective:To study the influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis accompanied by MODS.Methods: A total of 78 patients with severe acute pancreatitis complicated by MODS who were treated in our hospital between June 2012 and March 2016 were selected and divided into control group (n=39) and observation group (n=39) according to random number table. Control group were treated with routine treatment, observation group were treated with conventional treatment plus continuous blood purification, and serum inflammatory factors, liver function indexes and renal function indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of inflammatory factors, liver function indexes and renal function indexes were not statistically significant between two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, MCP-1 and HMGB1 levels of observation group were lower than those of control group, liver function indexes ALT, AST, TBIL and ALP levels of observation group were lower than those of control group, and renal function indexes Scr and BUN levels of observation group were lower than those of control group.Conclusion: Continuous blood purification can reduce the systemic inflammatory response as well as liver and kidney injury in patients with severe acute pancreatitis complicated by MODS.

Research on Nursing Effect of Individualized Nursing Intervention on Critically Ill Patients with Continuous Blood Purification

Objective:This paper aims to investigate the value of individualized care for critically ill patients receiving continuous blood purification therapy.Methods:89 cases of critically ill patients who were treated from June 2021 to June 2023 were randomly divided into groups,with individualized care in group A and routine care in group B.The differences in clinical indicators,purification effect,quality of life,and complications of blood purification were compared between the groups.Results:Heart rate,respiration,body temperature,and other indicators in group A were better than those in group B,P<0.05.C-reactive protein(CRP),β2-microglobulin(β2-MG),blood urea nitrogen(BUN),and phosphorus(P)in group A were lower than those in group B,P<0.05.Group A had higher quality of life than Group B,P<0.05.The complication rate of blood purification in Group A was lower than that in Group B,P<0.05.Conclusion:During continuous blood purification in critically ill patients,individualized nursing intervention can enhance the effect of blood purification,improve the physiological indicators of patients,and reduce the complications of blood purification,which is highly effective and feasible.

床旁高流量CBP联合血必净治疗重症脓毒症的效果及对凝血纤溶系统和血清PCT、NT-proBNP、cTnⅠ水平的影响

目的 探究床旁高流量连续性血液净化(CBP)联合血必净治疗重症脓毒症(SS)的效果,并分析其对凝血纤溶系统和血清降钙素原(PCT)、N末端B型脑钠尿肽前体(NT-pro BNP)、心肌肌钙蛋白(c Tn I)水平的影响。方法 采用随机数字表法将2021年11月—2023年11月本院急诊重症监护室收治的97例SS患者分为观察组(49例)和对照组(48例)。两组均接受基础治疗,对照组床边高流量CBP治疗,观察组联合血必净治疗,比较两组凝血纤溶系统指标、血清指标、免疫指标及近期预后。结果 治疗后1周,观察组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、纤维蛋白原(FIB)、PCT、NT-pro BNP、c Tn I、CD8^(+)水平均显著低于对照组(P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05);两组感染性休克发生率无显著性差异(P>0.05),但观察组重症监护室时间、机械通气时间、多器官功能障碍综合征发生率(MODS)均显著低于对照组(P<0.05),存活率显著高于对照组(P<0.05)。结论 床边高流量CBP联合血必净治疗SS患者能调节凝血、纤溶平衡,减轻心肌损伤,同时改善机体免疫功能,减少MODS的发生,提高存活率,促进患者康复。

连续性血液净化(CBP)治疗重症心力衰竭合并肾衰竭患者的临床疗效探究

分析连续性血液净化(continuous blood purification,CBP)治疗重症心力衰竭合并肾衰竭患者的临床疗效。选取2022年2月—2023年2月于医院接受治疗的50例重症心力衰竭合并肾衰竭患者为研究对象,随机将其分为对照组和观察组,每组各25例。对照组实施硝酸甘油治疗,观察组实施CBP治疗,对比两组患者的治疗效果、心功能指标以及肾功能指标。结果显示,观察组治疗效果、治疗后心脏功能指标以及肾功能指标均优于对照组(P<0.05)。研究发现,CBP治疗重症心力衰竭合并肾衰竭患者效果显著,可优化患者的治疗效果,改善患者的心脏功能指标以及肾功能指标,建议临床推广。

局部枸橼酸抗凝在高危出血患者CBP治疗中的应用及护理

目的探讨局部枸橼酸抗凝在高危出血患者连续性血液净化(CBP)治疗中的应用方法及护理对策。方法回顾性总结25例高危出血患者采用局部枸橼酸抗凝行CBP治疗的方法,对其治疗效果进行分析。结果患者血滤器平均使用时间为42.8h,2例患者在CBP过程中出现低血钙经补钙后好转。1例患者血气分析多次提示代谢性碱中毒,通过减少碳酸氢钠的输入量后改善。无患者在CBP过程中加重出血。结论局部枸橼酸抗凝,由于体外抗凝效果确切,且无体内抗凝作用,能有效防止出血并发症的发生,是高危出血倾向患者血液净化最理想的抗凝技术,护理上注意监测血气,电解质的变化,维持患者体内及滤器后钙离子的目标值,注意观察枸橼酸抗凝的相关并发症,即可减少枸橼酸抗凝行CBP治疗的风险。

早期局部枸橼酸抗凝下CBP对重型颅脑损伤预后影响的研究

目的:通过局部枸橼酸抗凝技术,探讨早期(伤后48 h内)实施持续血液净化(CBP)对重型颅脑损伤患者的治疗效果及预后的影响。方法:随机选取2017年1月-2019年6月广东省茂名市人民医院神经重症科收治的80例重型颅脑损伤患者为研究对象,按照随机数字表法将其分为试验组(40例)与对照组(40例)。对照组根据病情接受常规治疗,试验组接受常规治疗联合局部枸橼酸抗凝下CBP治疗。对比两组的治疗效果、脑水肿期常见并发症发生率、ICU 7 d转出率和预后,采用格拉斯哥昏迷评分(GCS)评估患者治疗前后临床生命体征缓解情况,采用格拉斯预后量表评分(GOS)评价患者伤后6个月的神经功能,统计预后生存及出院情况。结果:试验组患者治疗总有效率92.5%,高于对照组的75.0%(P<0.05)。试验组患者颅内压情况和脑水肿程度均优于对照组(P<0.05)。试验组脑水肿期的肺部感染率、连续3 d以上高热发生率、血钠浓度波动超15%发生率、急性肾损伤(AKI)发生率、BNP>1 000 pg/mL发生率、大面积水肿缺血或脑疝发生率、ICU 7 d转出率均低于对照组(P<0.05)。受伤后6个月,试验组格拉斯哥预后量表评分情况优于对照组,平均分高于对照组,差异均有统计学意义(P<0.05)。结论:通过局部枸橼酸抗凝,可对早期重型颅脑损伤患者实施持续血液净化治疗,一定程度上可改善治疗效果及预后,值得临床上推广使用。

CBP治疗对SAP患者的抗炎作用及治疗时机分析

目的分析重症急性胰腺炎(SAP)患者采用早期连续性血液净化(CBP)的抗炎作用和治疗时机.方法将44例重症急性胰腺炎患者依照奇偶数法的分组方式分为对照组和试验组,每组22例,对照组予以常规治疗,试验组予以早期连续性血液净化治疗,比较两组患者的临床疗效.结果试验组患者症状消失时间、体温恢复时间、血淀粉酶恢复时间、肠蠕动恢复时间及住院时间均比对照组明显缩短,组间差异具有统计学意义(P<0.05);与治疗前比较,两组患者治疗后IL-10、IL-6、IL-8、TNF-α等血清细胞因子水平明显降低,且试验组较对照组低,组间差异具有统计学意义(P<0.05);两组患者并发症发生率比较试验组明显低于对照组,差异具有统计学意义(P<0.05);试验组患者的好转率较对照组高,差异具有统计学意义(P>0.05);未愈率、死亡率两组比较差异无统计学意义(P>0.05).结论早期连续性血液净化可显著降低重症急性胰腺炎患者的炎症因子水平,同时可有效改善患者临床症状,减少并发症,促进预后转归.

小儿CBP治疗致滤器凝血的原因分析及护理干预

连续性血液净化（CBP）优点是血流动力学稳定，能有效控制氮质血症和酸碱、电解质平衡，快速清除过多液体，现已在医学各科中广泛应用。随着CBP技术的日益成熟及对疾病认识的不断深入， CBP技术在儿科急重症领域的应用也日渐增多。我科治疗对象是儿童，以婴幼儿居多，自2008年以来开展CBP治疗115例次，有效降低了危重患儿的死亡率，改善了患儿的预后，取得了满意的疗效。由于婴幼儿的特殊生理因素，各种技术和参数不完全同于成人，各种并发症发生率较高，其中以体外循环凝血较常见，本文将我科17例次发生滤器凝血的原因进行分析，现报告如下。

连续性血液净化(CBP)治疗危重症患者对机体氧化抗氧化指标的影响研究

目的:分析危重症采用连续性血液净化对治疗机体氧化抗氧化指标的影响。方法:选我院22例重症监护室行CBP治疗的患者,不同时间段取血,并检测血清过氧脂质(LPO)与谷胱甘肽氧化物酶(GSH-Px)的水平,行APACHEIII的评分。结果:相较于健康对照组,LPO升高,GSH-Px降低;在CBP的不同时间段治疗后,APACHEIII评分有着明显改善;LPO、GSH-Px与APACHEIII的评分分别呈正、负相关。结论:CBP可改善患者氧化抗氧化紊乱,从而减轻氧化损伤,促进危重症患者病情得到较好的改善,而LPO及GSH-Px是检测危重症患者病情轻重的关键指标,可作为判断预后与CBP停止的时机起到了重要的依据。

持续血液净化(CBP)配合护理干预治疗重症急性胰腺炎(SAP)的临床疗效

目的探讨重症急性胰腺炎(SAP)患者行持续血液净化(CBP)时加强整体护理干预对改善患者身体状态的作用。方法抽取我院2015年1月至2018年5月收治的重症SAP患者82例为研究对象,所有患者均行CBP治疗,40例治疗期间配合常规护理者作为对照组,42例配合整体护理干预者作为实验组,评估两组疗效。结果实验组治疗后炎性因子、RAAS指标及肝肾功能指标水平均显著低于对照组(P<0.05)。结论 CBP治疗重症SAP患者时,予以整体护理干预,有利于清除患者体内炎性因子,改善RAAS系统及靶器官功能,值得推广。

老年重型肾综合征出血热CBP疗效观察与分析

目的探讨连续性血液净化对老年重型肾综合征出血热患者的治疗效果。方法对14例老年重型肾综合征出血热患者应用连续静-静脉血液滤过-透析或连续静-静脉血液透析进行连续性血液净化治疗。结果治愈12例,死亡2例,无明显不良反应。结论老年重型肾综合征出血热患者对连续性血液净化治疗耐受性好,副作用极少,疗效佳。

老年重型肾综合征出血热CBP疗效观察与分析

目的探讨连续性血液净化对老年重型肾综合征出血热患者的治疗效果。方法对14例老年重型肾综合征出血热患者应用连续静—静脉血液滤过—透析或连续静—静脉血液透析进行连续性血液净化治疗。结果治愈12例、死亡2例。无明显不良反应。结论老年重型肾综合征出血热患者对连续性血液净化治疗耐受性好,副作用极少,疗效佳。

炎性细胞因子监测在判断CBP治疗SAP时机选择中的应用

目的 ：通过监测炎性细胞因子的变化,分析连续性血液净化（continuous blood purification,CBP）治疗重症急性胰腺炎（severe acute pancreatitis,SAP）的时机与疗效之间的关系。方法 ：SAP患者入院后即行CBP治疗,CBP治疗模式为连续性静脉-静脉血液滤过（continuity veno-venos hemofiltration,CVVHF）,每天治疗12 h,连续3 d。根据CBP治疗距SAP发病时间,将33例SAP患者随机分为A、B、C共3组,分别在SAP发病0~24、24~48、48~72 h开始给予CBP治疗。在CBP治疗开始及结束检测肿瘤坏死因子α（TNF-α）、白介素（IL）-1、IL-6、IL-8、血淀粉酶（amylase,AMY）、C反应蛋白（C-reactive protein,CRP）、APACHEⅡ评分等指标变化。结果：3组SAP患者经过CBP治疗后,TNF-α、IL-1、IL-6、IL-8等炎性细胞因子水平与AMY、CRP、APACHEⅡ评分等病情评估指标水平均较治疗前明显降低。比较3组SAP患者的AMY、CRP、APACHEⅡ评分等病情评估指标的降低幅度上,C组（48~72 h CBP治疗组）较A、B组（0~24、24~48 h CBP治疗组）明显减少;而TNF-α、IL-1、IL-6、IL-8等炎性细胞因子的降低幅度上,C组较A、B组明显增加。结论：通过CBP治疗可有效降低SAP患者炎性细胞因子的浓度,并改善病情。48 h内开始CBP治疗对SAP患者病情的改善幅度要优于48 h以后。