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
目的：观察改良日机装Aquarius连续性肾脏替代治疗（CRRT）实现血浆胆红素吸附（BA）联合连续性静脉-静脉血液滤过（CVVH）的疗效。方法收集2014年2月至2016年7月在中南大学湘雅医院重症医学科住院的高胆红素血症患者8例，所有患者均给...目的：观察改良日机装Aquarius连续性肾脏替代治疗（CRRT）实现血浆胆红素吸附（BA）联合连续性静脉-静脉血液滤过（CVVH）的疗效。方法收集2014年2月至2016年7月在中南大学湘雅医院重症医学科住院的高胆红素血症患者8例，所有患者均给予基本内科综合治疗，同时在此基础上实施BA联合CVVH治疗共25例次。观察患者治疗前后白蛋白（ALB）、总胆红素（TBil）、直接胆红素（DBil）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）等肝功能指标及凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶原活动度（PTA）、国际标准比值（INR）等凝血指标和血常规〔白细胞计数（WBC）、血小板计数（PLT）〕的变化，以及电解质和不良反应发生情况。结果治疗后1 h ALB（g/L：26.84±4.07比29.46±3.78）和治疗后1 h、24 h TBil、DBil均较治疗前明显降低〔TBil（μmol/L）：262.81±88.85、297.26±96.64比357.57±121.86，DBil （μmol/L）：129.84±42.24、141.60±49.60比173.76±56.22〕，治疗后1 h PT较治疗前明显延长（s：20.97±8.66比16.59±2.70），差异均有统计学意义（均P＜0.05）；而治疗前后ALT、AST、APTT、PTA、INR、WBC、PLT和电解质水平（K＋、Na＋）比较差异均无统计学意义（均P＞0.05）。结论在不改变现有设备硬件的情况下，对日机装Aquarius CRRT血液净化装置进行改良实现BA后再序贯进行CVVH治疗，充分发挥了两种模式的治疗作用，可以达到清除胆红素及水溶性毒素的目的。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.
文摘目的探究参附注射液辅助连续性静脉-静脉血液滤过(continuous veno-venous hemofil⁃tration,CVVH)治疗对重症脓毒血症患者血气指和肾功能的影响。方法方便选取2021年6月—2022年6月徐州医科大学附属医院重症医学科救治的104例伴急性肾衰竭的重症脓毒血症患者为研究对象,按照随机数表法分为研究组和对照组,各52例。对照组予以CVVH治疗,研究组在对照组的治疗基础上给予参附注射液进行干预。对比两组患者治疗前后的血气指标[氧分压(partial pressure of oxygen,PaO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、氧合指数(partial pressure of oxygen/fraction of inspired oxygen,PaO_(2)/FiO_(2))]、肾功能指标[血肌酐(serum creatinine,Cr)、尿素氮(blood urea nitrogen,BUN)]、感染性休克率及病死率。结果治疗后,研究组患者Cr(71.32±5.79)μmol/L、BUN水平(9.81±0.59)mmol/L明显低于对照组[(92.13±6.74)μmol/L,(10.63±0.68)mmol/L],差异有统计学意义(t=15.581、6.057,P均<0.001)。治疗后,两组患者的PaCO_(2)水平均下降,PaO_(2)以及PaO_(2)/FiO_(2)水平均上升,且研究组各项指标优于对照组,差异有统计学意义(P均<0.05)。研究组在治疗14 d内的感染性休克发生率9.62%明显低于对照组26.92%,差异有统计学意义(χ^(2)=4.121,P<0.05)。两组患者病死率差异无统计学意义(P>0.05)。结论对严重脓毒血症患者在CVVH治疗基础上辅以参附注射液进行干预,可有效改善肺和肾的功能,有助于降低感染性休克率及病死率,改善临床预后。
文摘目的探讨连续性静脉静脉血液滤过(continuous veno-venous hemofiltration,CVVHF)治疗中置换液剂量对危重急性肾损伤患者预后的影响。方法所有患者资料均来源于上海市医学发展基金重点研究课题《急性肾衰竭的早期发现与防治》数据库。选取数据库中发生急性肾损伤,并进行CVVHF治疗且置换液量>30ml/(kg·h)的患者74例,其中男性48例,女性26例,年龄(55.8±17.7)岁(19～87岁)。将患者分成两组:①CVVHF-A组(37例):置换液剂量为30～40ml/(kg·h);②CVVHF-B组(37例):置换液剂量>40ml/(kg·h)。观察两组患者透析前后生命体征及血生化指标的变化,同时在治疗前、治疗第4d和治疗结束后用急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)Ⅱ评估疾病严重性,评估两组患者在30d和60d时的患者生存率和肾存活率,观察不同置换液剂量对急性肾损伤患者预后的影响。结果两组患者的基础情况包括性别、年龄、一周内手术史、慢性肾脏疾病史、糖尿病史和肾功能以及治疗前的血气分析、肾功能、心率、平均动脉压(mean arterial pressure,MAP)、尿量、多器官功能障碍综合征和全身炎症反应综合征发生率、APACHEⅡ评分均相匹配(P>0.05)。CVVHF-A组患者的平均置换液量为(33.4±3.3)ml/(kg·h),CVVHF-B组患者的平均置换液剂量为(53.2±8.5)ml/(kg·h),两组相比差异有统计学意义(P<0.001)。单次CVVHF治疗后患者的血PH、HCO3-、K+、尿素氮和肌酐均较治疗前显著改善(P<0.05),而心率、MAP和Na+在治疗前后差异均无统计学意义(P>0.05)。Kaplan-Meier生存曲线分析结果显示CVVHF-A组患者30d和60d的生存率分别为48.7%和40.5%;CVVHF-B组患者30d和60d的生存率分别为56.8%和48.6%,Log-Rank检验显示两组生存率差异均无统计学意义(P=0.724)。肾存活与患者存活结果相似。结论在危重急性肾损伤患者中应用CVVHF治疗时,30ml/(kg·h)以上的置换液剂量可以显著纠正代谢性酸中毒,改善肾功能,而对血液动力学影响不大。40ml/(kg·h)以上的置换液剂量与30～40ml/(kg·h)的剂量相比并未显示出更多的优势。
文摘目的：观察改良日机装Aquarius连续性肾脏替代治疗（CRRT）实现血浆胆红素吸附（BA）联合连续性静脉-静脉血液滤过（CVVH）的疗效。方法收集2014年2月至2016年7月在中南大学湘雅医院重症医学科住院的高胆红素血症患者8例，所有患者均给予基本内科综合治疗，同时在此基础上实施BA联合CVVH治疗共25例次。观察患者治疗前后白蛋白（ALB）、总胆红素（TBil）、直接胆红素（DBil）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）等肝功能指标及凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶原活动度（PTA）、国际标准比值（INR）等凝血指标和血常规〔白细胞计数（WBC）、血小板计数（PLT）〕的变化，以及电解质和不良反应发生情况。结果治疗后1 h ALB（g/L：26.84±4.07比29.46±3.78）和治疗后1 h、24 h TBil、DBil均较治疗前明显降低〔TBil（μmol/L）：262.81±88.85、297.26±96.64比357.57±121.86，DBil （μmol/L）：129.84±42.24、141.60±49.60比173.76±56.22〕，治疗后1 h PT较治疗前明显延长（s：20.97±8.66比16.59±2.70），差异均有统计学意义（均P＜0.05）；而治疗前后ALT、AST、APTT、PTA、INR、WBC、PLT和电解质水平（K＋、Na＋）比较差异均无统计学意义（均P＞0.05）。结论在不改变现有设备硬件的情况下，对日机装Aquarius CRRT血液净化装置进行改良实现BA后再序贯进行CVVH治疗，充分发挥了两种模式的治疗作用，可以达到清除胆红素及水溶性毒素的目的。
基金福建省中青年教师教育科研项目(JA15224) Scientific Research Project Foundation of the Educational Committee of Fujian Province for Young and Middle Aged Teachers (JA15224)
