Comparison of therapeutic effects between different blood purification therapies for treatment of patients with multiple organ dysfunction syndrome
10.3969/j.issn.1008-9691.2017.04.019
- VernacularTitle:不同血液净化方式治疗多器官功能障碍综合征的临床疗效比较
- Author:
Anping LIU
;
Qian YANG
;
Peng YE
;
Anyong YU
;
Xue XIAO
- Keywords:
Continuous veno-venous hemofiltration;
Continuous veno-venous hemodiafiltration;
Multiple organ dysfunction syndrome
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2017;24(4):415-418
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the clinical therapeutic effects of continuous veno-venous hemofiltration (CVVH) and continuous veno-venous hemodiafiltration (CVVHDF) for treatment of patients with multiple organ dysfunction syndrome (MODS).Methods A prospective observation was conducted, seventy patients with MODS admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Zunyi Medical College from September 2013 to December 2016 were enrolled, and they were divided into a CVVH group and a CVVHDF group according to different treatment, 35 cases in each group. In the CVVH group, the ultrafiltration fluid flow rate was set at 1800 mL/h, while in the CVVHDF group, the flow rate was set at 2000 mL/h for both substitution fluid and dialysate, and the blood flow of the two groups was 150-180 mL/min. The changes of creatinine (SCr), urea nitrogen (BUN), pH value, HCO3-, helper T cell (Th1, Th2) and Th1/Th2 ratio were compared between the two groups before and after treatment for 24, 48 and 72 hours.Results With the extension of time, SCr, BUN were reduced in both groups after treatment compared to those before treatment, 72 hoursafter treatment they reached the lowest value, and the degree of change in CVVHDF group was more significant than that in CVVH group [SCr (μmol/L): 150.62±32.09 vs. 180.41±30.52, BUN (mmol/L): 7.31±2.19 vs. 9.06±2.36. allP < 0.05], after treatment; the pH value, HCO3- level in the two groups had a tendency at first elevated and then lowered, 48 hours after treatment they reached the peak values, compared with those before treatment, the differences were statistically significant [CVVH group: the pH value 7.42±0.08 vs. 7.25±0.10, HCO3- (mmol/L) was 22.49±5.11 vs. 15.65±4.16; CVVHDF group: pH value 7.41±0.04 vs. 7.24±0.11, HCO3- (mmol/L) 23.24±4.78 vs. 15.65±4.16, allP < 0.05], 72 hours after treatment, they began reduced (CVVH group: pH value, HCO3- were 7.39±0.09, 22.35±4.91 respectively, CVVHDF group: pH value, HCO3- were 7.38±0.06, 23.13±4.61 respectively), but they were still significantly higher than those before treatment, and at each time point compared between the two groups, no statistical significant difference was seen (allP > 0.05). With the extension of therapeutic time, Th1, Th1/Th2 in two groups were gradually elevated after treatment, and 72 hours after treatment they reached the peak values; Th2 showed a trend of gradual decrease and after 72 hours of treatment it reached the lowest value, and the changes in CVVHDF group were more significant than those in CVVH group [Th1 (×10-2): 1.51±0.12 vs. 1.21±0.11, Th2 (×10-2): 1.64±0.65 vs. 1.70±0.18, Th1/Th2: 0.91±0.14 vs. 0.71±0.15, allP < 0.05].Conclusion Both CVVH and CVVHDF can effectively remove inflammatory mediators and metabolic products, adjust the balance of acid and base, regulate immune system in the body of patients with MODS, and the CVVHDF is more effective than CVVH.
