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...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。展开更多
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 sev...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.展开更多
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 acut...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.展开更多
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 hyp...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.展开更多
目的探讨连续血液净化(continuous blood purification,CBP)对重症脓毒症患者的疗效。方法选取2021年1月—2023年10月福州市长乐区人民医院收治的90例重症脓毒症患者纳入研究。以随机数字表法分为对照组与观察组,各45例。对照组给予常...目的探讨连续血液净化(continuous blood purification,CBP)对重症脓毒症患者的疗效。方法选取2021年1月—2023年10月福州市长乐区人民医院收治的90例重症脓毒症患者纳入研究。以随机数字表法分为对照组与观察组,各45例。对照组给予常规治疗,观察组在此基础上予以CBP治疗。对比炎症因子水平、平均动脉压(mean arterial pressure,MAP)、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))/吸入氧浓度(inhalation oxygen concentration,FiO_(2))、血乳酸水平、急性生理与慢性健康评分(acute physiology and chronic health evaluation scoring system,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、免疫指标、并发症发生率及治疗48 h后去甲肾上腺素用量。结果观察组C-反应蛋白(C-reactiveprotein,CRP)为(36.25±10.12)pg/mL、白细胞介素6(interleukin 6,IL-6)为(115.22±20.46)ng/L、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)为(56.78±12.58)ng/L,低于对照组的(59.42±11.33)pg/mL、(131.72±21.38)ng/L、(65.89±13.63)ng/L(P<0.05)。观察组血乳酸水平为(2.11±0.17)mmoI/L、APACHEⅡ为(17.05±2.09)分、S O F A为(5.06±0.64)分,低于对照组的(2.53±0.27)mmoI/L、(21.95±2.15)分、(7.32±0.78)分(P<0.05)。观察组MAP、PaO_(2)/FiO_(2)、CD4阳性淋巴细胞(CD4-positive T lymphocytes,CD4^(+))、CD8阳性淋巴细胞(CD8-positive T lymphocytes,CD8^(+))及CD4^(+)/CD8^(+)优于对照组(P<0.05)。观察组并发症总发生率、治疗48 h后去甲肾上腺素用量低于对照组(P<0.05)。结论CBP治疗重症脓毒症者可抑制炎症反应,改善免疫功能,并可能改善患者结局。展开更多
文摘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。
文摘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.
文摘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.
基金Supported by Natural Science Foundation of Heilongjiang Province,China
文摘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.
文摘目的探讨连续血液净化(continuous blood purification,CBP)对重症脓毒症患者的疗效。方法选取2021年1月—2023年10月福州市长乐区人民医院收治的90例重症脓毒症患者纳入研究。以随机数字表法分为对照组与观察组,各45例。对照组给予常规治疗,观察组在此基础上予以CBP治疗。对比炎症因子水平、平均动脉压(mean arterial pressure,MAP)、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))/吸入氧浓度(inhalation oxygen concentration,FiO_(2))、血乳酸水平、急性生理与慢性健康评分(acute physiology and chronic health evaluation scoring system,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、免疫指标、并发症发生率及治疗48 h后去甲肾上腺素用量。结果观察组C-反应蛋白(C-reactiveprotein,CRP)为(36.25±10.12)pg/mL、白细胞介素6(interleukin 6,IL-6)为(115.22±20.46)ng/L、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)为(56.78±12.58)ng/L,低于对照组的(59.42±11.33)pg/mL、(131.72±21.38)ng/L、(65.89±13.63)ng/L(P<0.05)。观察组血乳酸水平为(2.11±0.17)mmoI/L、APACHEⅡ为(17.05±2.09)分、S O F A为(5.06±0.64)分,低于对照组的(2.53±0.27)mmoI/L、(21.95±2.15)分、(7.32±0.78)分(P<0.05)。观察组MAP、PaO_(2)/FiO_(2)、CD4阳性淋巴细胞(CD4-positive T lymphocytes,CD4^(+))、CD8阳性淋巴细胞(CD8-positive T lymphocytes,CD8^(+))及CD4^(+)/CD8^(+)优于对照组(P<0.05)。观察组并发症总发生率、治疗48 h后去甲肾上腺素用量低于对照组(P<0.05)。结论CBP治疗重症脓毒症者可抑制炎症反应,改善免疫功能,并可能改善患者结局。
