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 J...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.展开更多
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 ...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.展开更多
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 8...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.展开更多
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 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 wit...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.展开更多
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 i...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.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
Objectives To evaluate the safety and define the contraindication of regional citrate anticoagulation treatment on various critically ill patients being treated by continuous blood purification, who also had bleeding ...Objectives To evaluate the safety and define the contraindication of regional citrate anticoagulation treatment on various critically ill patients being treated by continuous blood purification, who also had bleeding tendencies. Methods Forty critically ill patients being treated by continuous blood purification (CBP) were involved in this study. Due to their bleeding tendencies, regional citrate anticoagulation treatment was given to all of them. Those with hepatic function impairment (n=10) were classified as Group A, those with hypoxemia were classified as Group B (n=10), and the others as Group C (n=20). Blood samples were collected before treatment, and at 4, 12, 24, 36, and 48 hour intervals during CBP. These samples then were used arterial blood gas analysis, whole blood activated clotting time (WBACT) pre- and post-filter, and serum ionized calcium examination. Results WBACT pre-filter showed little fluctuant through the 48hr period of CBP, and WBACT post-filter showed obvious prolongation than that of the pre-filter (P<0.05) at all time points. Metabolic acidosis was found in Group A patients before CBP, and improved during CBP. Normal acid-base conditions of patients were disturbed and deteriorated in Group B during CBP, but not in Group C. Serum ionized calcium was maintained at a normal range during CBP in Group A and C patients, but declined significantly in Group B patients (vs. pre-treatment, P<0.05). Conclusions Regional citrate anticoagulation can be safely used in conjunction with CBP treatment for patients with hepatic function impairment , but may induce acidosis and a decline in serum ionized calcium when used with hypoxemic patients.展开更多
文摘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.
文摘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.
文摘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.
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 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.
文摘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.
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.
基金ThisstudywassupportedbyPLATenth Five YearStudyPlan(No 0 1L0 0 7)
文摘Objectives To evaluate the safety and define the contraindication of regional citrate anticoagulation treatment on various critically ill patients being treated by continuous blood purification, who also had bleeding tendencies. Methods Forty critically ill patients being treated by continuous blood purification (CBP) were involved in this study. Due to their bleeding tendencies, regional citrate anticoagulation treatment was given to all of them. Those with hepatic function impairment (n=10) were classified as Group A, those with hypoxemia were classified as Group B (n=10), and the others as Group C (n=20). Blood samples were collected before treatment, and at 4, 12, 24, 36, and 48 hour intervals during CBP. These samples then were used arterial blood gas analysis, whole blood activated clotting time (WBACT) pre- and post-filter, and serum ionized calcium examination. Results WBACT pre-filter showed little fluctuant through the 48hr period of CBP, and WBACT post-filter showed obvious prolongation than that of the pre-filter (P<0.05) at all time points. Metabolic acidosis was found in Group A patients before CBP, and improved during CBP. Normal acid-base conditions of patients were disturbed and deteriorated in Group B during CBP, but not in Group C. Serum ionized calcium was maintained at a normal range during CBP in Group A and C patients, but declined significantly in Group B patients (vs. pre-treatment, P<0.05). Conclusions Regional citrate anticoagulation can be safely used in conjunction with CBP treatment for patients with hepatic function impairment , but may induce acidosis and a decline in serum ionized calcium when used with hypoxemic patients.
