Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
ObjectiveTo investigate the effect of polymyxin B hemoperfusion on the prognosis of patients with sepsis and septic shock by meta-analysis.MethodsSupplemented by manual search and document traceability, the US National Library of Medicine Pubmed, the Dutch Medical Abstracts Embase database, and the Cochrane clinical trial database were searched. Randomized controlled trials (RCTs) were collected from January 1998 to October 2018 for the treatment of sepsis and septic shock with polymyxin B hemoperfusion, only limited to English publications. The collected RCTs were evaluated and the prognosis of patients with sepsis and septic shock was analyzed by the Cochrane Collaboration.ResultsFinally six RCTs were included, and a total of 926 patients were analyzed, with 471 patients in the polymyxin B hemoperfusion group and 455 patients in the control group. The mortality rate was 36.3% (171/471) in the polymyxin B hemoperfusion group and 39.1% (178/455) in the control group. Hemoperfusion with polymyxin B could not reduce the patient mortality (RR=0.80, 95% CI 0.56 to 1.15, P=0.233). A subgroup analysis was taken on the patients with moderate to severe septic shock. Four RCTs were included in total and 418 patients were analyzed, with 207 patients in the polymyxin B hemoperfusion group and 211 in the control group. The mortality rate was 38.65% (80/207) in the polymyxin B hemoperfusion group and 50.71% (107/211) in the control group were. The hemoperfusion of polymyxin B could significantly reduce the mortality of patients with moderate to severe septic shock (RR=0.70, 95% CI 0.52 to 0.96, P=0.025).ConclusionsOlymyxin B hemoperfusion can not improve the prognosis of patients with sepsis and septic shock. However, compared with conventional treatment, polymyxin B hemoperfusion can improve the 28-day mortality rate of patients of severe septic shock. Due to the limit number of randomized controlled trials, more high-quality trials are needed to a further confirmation.
We established acute cholangitis and endotoxiemia in 18 rabbits by ligating the common bile duct and injecting E coli(O111B4 strain)into the common bile duct. After perfusion through activated charcoal via femoral artery-vein pathway, the average blood levels of endotoxin decreased sighificantly from 2.24Eu/ml to 0.17Eu/ml(Plt;0.001). This result suggested that blood perfusion through activated charcoal may be a promising therapy for acute endotoxemia.
Objective To study the clinical protective effect of hemoperfusion combined with hemofiltration on inflammatory reaction of hyperlipidemia severe acute pancreatitis (HLSAP). Methods Thirty-seven patients with HLSAP treated between January 2012 and December 2014 were selected and divided into three groups based on different treatments. Thirteen patients were allocated into hemoperfusion combined with continuous veno-venous hemofiltration group (HP+CVVH group) and treated with hemoperfusion combined with hemofiltration; 11 patients were allocated into continuous veno-venous hemofiltration group (CVVH group) and treated with hemofiltration; and all the other patients were allocated into control group and treated with conventional treatment. The levels of blood triglyceride, C-reactive protein, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) and acute physiology and chronic health evaluation (APACHE)Ⅱ score of the patients after treatment were observed. The hospital stay, organ dysfunction rate and mortality of the patients were measured. Results Compared with the control group, the levels of blood triglyceride, C-reactive protein, TNF-α, IL-6, IL-8 and APACHE Ⅱ score of the patients in the HP+CVVH group and CVVH group were both significantly reduced 72 hours after therapy (P<0.05). However, the levels of blood triglyceride, C-reactive protein, TNF-α, IL-6, IL-8 and APACHE Ⅱ score of the patients in the HP+CVVH group were significantly lower than those in the CVVH group at the same time point (P<0.05). The hospital stay of the patients in the HP+CVVH group and CVVH group was significantly shorter than that in the control group (P<0.05). Compared with the CVVH group, the hospital stay of patients in the HP+CVVH group was significantly shorter (P<0.05). There was no statistical difference in organ dysfunction rate and mortality among the three groups (P>0.05). Conclusion Hemoperfusion combined with hemofiltration is an effective method for HLSAP by cleaning the inflammatory mediators availably and inhibiting the excessive inflammatory reaction.
Objective To evaluate the effect of hemoperfusion for absorption of inflammatory cytokines on sepsis . Method A prospective randomized controlled study was carried out to collect 60 sepsis patients admitted to the Department of Critical Care Medicine of this hospital from June 2019 to December 2021. They were randomly divided into a study group (30 cases) and a control group (30 cases) by using the random number table method. Both groups of patients received routine treatment according to the guidelines, including fluid resuscitation, mechanical ventilation, antibiotic and vasoactive agents. For the patients with renal failure, renal replacement therapy (RRT) was used. Routine vital sign monitoring and serum procalcitonin (PCT) and interleukin-6 (IL-6) determination were recorded. The study group received two times of hemoperfusion to absorb inflammatory cytokines at 0 h and 24 h after enrollment. At 24 h and 48 h after treatment, the vital signs and related physical and chemical indexes of patients were recorded again, including norepinephrine dose, oxygenation index, PCT, IL-6 and blood lactic acid. The changes of physical and chemical indexes and the 28-day survival rate of the two groups were compared. Results There was no difference in the general situation of the two groups when they were enrolled (P>0.05). The dosage of norepinephrine [(0.77±0.48)μg·kg–1·min–1 vs. (0.92±0.62) μg·kg–1·min–1, P=0.030] and the level of blood lactic acid [(2.70±1.43)mmol/L vs. (4.05±2.60)mmol/L, P=0.001] in the study group were significantly lower than those in the control group 24 h and 48 h after treatment. The oxygenation index in the study group was higher than that of the control group 24 h after treatment (212±68)mm Hg vs. (197±42)mm Hg, P=0.042). The inflammation related indexes PCT [(17±24)ng/mL vs. (32±36)ng/mL, P=0.013] and IL-6 [299 (102, 853)pg/mL vs. 937 (247, 2230)pg/mL, P=0.026] in the study group were significantly lower than those in the control group 48 h after treatment. The dosage of noradrenaline, oxygenation index, PCT, IL-6 and blood lactate level in the study group after treatment were improved compared with those before treatment (P<0.05), while those in the control group were not significantly improved after treatment (P>0.05), and oxygenation index in the two groups had no significant difference before and after treatment (P>0.05). There was no significant difference in the 28-day survival rate between the two groups (χ2=0.211, P=0.646). Conclusion Although the hemoperfusion for absorption of inflammatory cytokine factors can not reduce the 28-day mortality of sepsis, it can significantly improve the early physical and chemical indicators of patients, and provide opportunities for follow-up treatment.
目的 通過比較三種血液凈化方式對炎癥介質、甲狀旁腺激素等中大分子毒素的清除效果，并觀察促紅細胞生成素（EPO）的治療效果，探尋有利于腎性貧血改善的最佳透析模式。 方法 2011年5月－8月采用前瞻性、隨機對照、開放式設計，選擇維持性血透患者60例，隨機分成3組，每組20例。血液灌流（HDP）組[每2周5次血液透析（HD）+1次HDP]、血液透析濾過治療（HDF）組（每2周5次HD+1次HDF）、HD組（每2周6次HD），隨訪3個月。檢測試驗前后反應蛋白（CRP）、β2微球蛋白、甲狀旁腺素（PTH）、白介素-6的水平以及各組患者腎性貧血指標的變化。 結果 3個月試驗結束時，HDP組和HDF組4項尿毒癥毒素水平均顯著下降，其中HDP組CRP水平明顯低于HDF組（P＜0.05）；HDP組和HDF組試驗后的血紅蛋白水平較試驗前升高，ERI值下降。HD組試驗前后的毒素水平無明顯變化，ERI值升高。3組患者均未出現嚴重不良事件。 結論 HDP和HDF清除中大分子毒素的能力優于HD，有利于緩解微炎癥狀態，改善EPO治療效果。HDP和HDF的遠期效果哪種更好，尚有待于進一步的研究。
目的:總結急性重癥中毒并急性腎功能衰竭(ARF)的臨床特點并探討多種血液凈化(BP)模式搶救急性重癥中毒的臨床療效。方法:回顧性分析我院30例急性中毒并ARF患者,其中9例行血液透析(HD)治療,11例行HD串聯血液灌流(HD＋HP)治療,10例采用連續性靜脈-靜脈血液透析濾過(CVVHDF)治療,各組均給予綜合性治療,比較單純HD組、HD＋HP組、CVVHDF組之間治療效果。結果:CVVHDF組治愈率高,腎功能恢復優于其他血液凈化組(P﹤0.05),昏迷者的清醒時間快,住院時間縮短(P﹤0.05),無明顯毒副作用。結論:CVVHDF、HD＋HP血液凈化治療搶救各種急性中毒并ARF患者成功率高,對急性重癥中毒伴多器官功能障礙者,提倡早期行CVVHDF治療,同時重視洗胃、營養支持、水電解質酸堿平衡、抗感染等綜合治療,以利于急危重癥中毒患者的救治。
探討血液灌流（HP）對急性藥物中毒患者血中毒物的清除作用及臨床療效。方法：收集我院2002年7月～2006年12月住院的鼠藥（主要為毒鼠強、四亞甲基二砜四胺）和部分藥物中毒患者69例，其中34例按常規給予洗胃、解毒、排毒、保肝、利尿或呼吸支持等綜合治療（非HP組），35例在綜合治療基礎上同時給予HP。通過觀察灌流前后的臨床療效。結果：HP組35例中死亡3例，生存率91.4%，非HP組34例中死亡5例，生存率85.3%（P＞0.05）。HP組病程明顯縮短（P＜0.05）。HP后患者意識清醒及抽摔停止時間較非HP組顯著提前。通過對清除率的計算發現：不同藥物的清除效果有差異，其中氮卓類清除效果好，清除率為（91.6±12.5）%。結論：HP能不同程度清除體內毒物，可明顯縮短病程、減少并發癥，對于急性重度中毒可望提高生存率。
目的 觀察三種不同血液凈化方式[血液透析（HD）、血液透析濾過（HDF）、血液透析+血液灌流（HD+HP）]對維持性血液透析患者高磷血癥清除效果。 方法 選擇2009年2月－2011年2月行維持性血液透析的48例高磷血癥患者為研究對象，所有患者在低鈣透析（1.25 mmol/L）的基礎，隨機分為HD組、HDF組、HD+HP組，每組16例，分別在治療時及治療后4周、8周檢查鈣、磷、鈣磷乘積和全段甲狀旁腺激素，并觀察其變化。 結果 在治療4周、8周后，HDF組、HD+HP組磷較前均顯著下降（P值均＜0.05），兩組同時點相比較差異無統計學意義（P＞0.05）；HD組較前血磷無明顯變化（P＞0.05）。 結論 HDF、HP清除維持性血液透析患者高磷有顯著的效果，而HD效果則不佳。