Clinical observation of bedside continuous blood purification in the treatment of multiple organ dysfunction syndrome

Clinical observation of bedside continuous blood purification in the treatment of multiple organ dysfunction syndrome

Objective To observe the curative effect of traditional bedside continuous blood purification (CBP) on multiple organ dysfunction syndrome (MODS). Methods 2 1 MODS patients were treated with CBP on the basis of traditional treatment. Intravenous hemofiltration (CVVH) mode, the filter is AN69 membrane, the replacement fluid volume is 3000 ~ 4500 ml/h, and the blood flow is150 ~180 ml/h. All patients underwent continuous hemofiltration for 72 hours, and the filter was changed every 24 hours. The changes of mean arterial pressure, heart rate, respiration and peripheral oxygen saturation before and after CBP were observed dynamically. Monitor aspartate aminotransferase, urea nitrogen, creatinine, electrolyte and blood gas, and score APACHEⅱⅱ every 24 hours. Results After CBP treatment, blood pressure, heart rate, respiration and peripheral oxygen saturation gradually returned to normal. APACHE score decreased significantly (t = 13.76, P < 0.5438+0). Blood potassium, AST, urea nitrogen and creatinine were significantly improved (t = 3.82 ~ 20.79, P < 0.0 1). Of 2 1 patients, 16 was cured and discharged, and the survival rate was 76.2%. Conclusion CBP can significantly improve the patient's condition and reduce the mortality rate while traditional treatment of MODS.

Keywords Hemofiltration Treatment of Multiple Organ Dysfunction Syndrome Results

[Abstract] Objective To evaluate the effect of continuous blood purification (CBP) on patients with multiple organ dysfunction syndrome (MODS). Method 20? 1 MODS patients received CVVH, 1 CBPs. The displacement fluid volume is 3000 ~ 4500mL/h, and the blood flow is 65438 050 ~ 65438 080ml/h.. All patients underwent CBP for 72 hours. The filter is replaced every 24 hours. The vital signs, APACHE score, arterial blood gas analysis, blood anions and liver and kidney function were observed. Results The vital signs returned to normal after CBP. APACHE score decreased significantly (t= 13.76, P & lt0.0 1), and the levels of serum potassium, aspartate aminotransferase (AST), blood urea nitrogen (BUN) and serum creatinine (Scr) improved significantly (t=3.82-20.79, P< 0.0). Conclusion Extracorporeal circulation can improve the condition of MODS patients and reduce the mortality.

[Keywords] Multiple organ dysfunction syndrome; Hemofiltration; Treatment outcome

Multiple organ dysfunction syndrome (MODS) is a critical disease that is often treated in ICU. There was no specific treatment in the past, which was one of the main causes of patients' death. In recent years, with the application of blood purification technology in ICU, the mortality rate of MODS has obviously decreased, and it has become an important and effective prevention and treatment means of MODS. We treated 2 1 MODS patients with continuous blood purification (CBP) and achieved satisfactory results. The report is as follows.

1 data and methods

1. 1 general information

2 1 of MODS patients meet the criteria jointly formulated by American College of Chest Physicians and Critical Care Medicine Association [1], and all of them are ICU inpatients. 2 1 patients, male 12, female 9. The age was 2 1 ~ 78 years, with an average of 56.4 years. Primary diseases: 8 cases of acute severe pancreatitis, 3 cases of cardiopulmonary cerebral resuscitation, 3 cases of postoperative pulmonary infection, 65,438+0 cases of postpartum hemorrhage and postpartum DIC, 2 cases of multiple injuries, 65,438+0 cases of severe brain contusion and laceration, and 2 cases of intestinal fistula. Renal insufficiency 12 cases, hepatic insufficiency 9 cases, acute respiratory distress syndrome 10 cases, cardiac insufficiency 10 cases, shock 9 cases, stress ulcer 7 cases and nervous system dysfunction 3 cases. Among them, there were 8 cases of 2 organ dysfunction, 6 cases of 3 organ dysfunction, 5 cases of 4 organ dysfunction and 2 cases of 5 organ dysfunction.

1.2 method

1.2. 1 Primary treatment All patients were given routine treatment according to their specific conditions.

1.2.2 CBP used seldinger puncture technique for central venous catheterization, including internal jugular vein catheterization in 8 cases, subclavian vein catheterization in 3 cases and femoral vein catheterization in 10 cases. Using Prisma hemofiltration machine, the filter is a69 membrane with a membrane area of 0.9m2 ...? In the venous hemofiltration (CVVH) mode, the replacement fluid volume is 3000 ~ 4500ml/h, and the blood flow is 65438 050 ~ 65438 080ml/h. The replacement solution is input by pre-dilution. The ultrafiltration volume per hour is set according to the specific situation. Ordinary heparin anticoagulates, and the dosage of heparin is adjusted by measuring partial prothrombin time (APTT). All patients underwent continuous hemofiltration for 72 hours, and the filter was changed every 24 hours. Blood samples were collected from the arterial end before and after treatment. The average time from MODS to CBP was (2.7 65438 0.2) d.

1.2.3 monitoring indicators dynamically observe the changes of mean arterial pressure (MAP), heart rate (HR), respiration (r) and peripheral blood oxygen saturation (SpO2) before and after treatment, and dynamically detect aspartate aminotransferase (AST) and urea nitrogen before and after treatment.

Bear fruit

2. 1 Changes of heart rate, heart rate, mean arterial pressure and blood oxygen saturation in patients.

After 12 ~ 72h CBP treatment, the HR, R, MAP and SpO2 of patients were significantly different from those before treatment (t =-44.96 ~ 24.98, P < 0.0 1). See table 1. After CBP treatment, the pressor drugs in 9 patients with shock gradually decreased, and all 7 patients stopped using pressor drugs after 72 hours. Effects of table 1 CBP on heart rate, heart rate, mean arterial pressure and blood oxygen saturation in patients.

2.2 APACHE score and changes of biochemical and blood gas indexes

After 72 hours of CBP treatment, APACHE scores of all patients decreased significantly (t= 13.76, P < 0.05438+0). 12 patients with renal failure, after 72 hours of CBP treatment, the levels of urea nitrogen and creatinine decreased significantly compared with those before treatment (t=3.82, 8.05, P < 0.0 1). In 9 patients with liver failure, AST decreased significantly after CBP treatment (t= 13.42, P < 0.05438+0). After 72 h of CBP treatment, the levels of serum potassium, pH and HCO-3 were significantly different from those before treatment (t =-20.58 ~ 20.79, P < 0.0 1). See Table 2. 1 1 ARDS patients, the average PaO2 before CBP treatment was (5.921.54) kpa, and after CBP treatment for 72 h, the average PaO2 was (11.391.89). 2.3 Adverse reactions

In 1 patient, the body temperature increased obviously after 48 h of CVVH treatment, but it dropped to normal after removing the catheter and replacing the puncture catheter. Hand and foot convulsion 1 case, improved after intravenous injection of calcium gluconate; Two patients with tracheal intubation and two patients with gastrointestinal decompression were treated with CBP, and the bleeding stopped after heparin was stopped.

2.4 Clinical results

Of 2 1 patients, 6 were cured and discharged1patients, with a survival rate of 76.2% and a mortality rate of 23.8%. Among the 5 patients who died, 2 cases were complicated with 5 organ dysfunction and 3 cases with 4 organ dysfunction. 3 discussion

MODS refers to a syndrome in which two or more living organs or systems, such as heart, lung, brain, liver, kidney, central nervous system, digestive tract and coagulation system, are diseased. Simultaneous or gradual dysfunction after 24 hours of acute injury, shock, infection, etc. It is the result of a severe blow to the body and one of the main causes of death of critically ill patients. The pathogenesis of multiple organ dysfunction syndrome is complex and not fully understood. The possible mechanism is: the role of inflammatory transmitters and/or ischemia-reperfusion injury. Since people have known about MODS, there has been no specific treatment, and the mortality rate is still high. Previous clinical trials aimed at neutralizing or blocking some inflammatory transmitters ended in failure [2]. In 1970s, CBP was used to treat all kinds of critical diseases, and achieved obvious curative effect [3,4], which was listed as one of the important advances in the treatment of critical diseases in recent 20 years. CBP therapy is characterized by continuous and slow removal of inflammatory transmitters, endotoxin and water, adjustment of electrolyte and acid-base balance, and improvement of tissue oxygen supply. At the same time, due to the small change of osmotic pressure and stable hemodynamic state, it has fewer side effects than conventional intermittent hemodialysis [5 ~ 10].