| Abstract Objective Severe sepsis in critically ill children is,by far,the primary cause of death among children.It has high incidence,progresses rapidly and high mortality.To date,there is no ideal treatment for it.In this study,by observing the efficacy of continuous veno - venous hemofiltration(CVVH) in children with severe sepsis and the influence on levels of inflammatory mediators,we aimed to explore its mechanism,and so as to provide a theoretic basis for continued renal replacement therapy on children with severe sepsis.Method Nineteen cases of children with severe sepsis were collected from PICU of our hospital between June 2005 and June 2008.All patients were selected in line with the 2005 Meeting of the International Sepsis published diagnostic criteria for severe sepsis in children.All patients received continuous renal replacement treatment for more than 48 hours.19 cases of children required mechanical ventilation.12 cases needed dopamine and norepinephrine to maintain blood pressure.Before CVVH,the average number of organ dysfunction was 3.42.Continuous veno - venous hemofiltration therapy was added on conventional combination therapy.(1) Blood samples were collect at four points of CVVH treatment:0 hours,12 hours,24 hours and 48 hours respectively.Each volume of 2ml blood samples were taken for conventional biochemical tests of the blood urea nitrogen,creatinine,blood lactate level at different time points.(2) At the same time,arterial blood gas analysis was done at different time points.(3) In 12 cases with shock,inotropic drug dosage and urine volume were compared at each time points..(4) In the beginning of CVVH treatment(0 hours),12 hours,24 hours and 48 hours time point,5ml arterial blood from the radial artery was taken.A biotin-avidin immune enzyme-linked immunosorbent assay was used to determine inflammation mediators of IL-8,IL-10 and TNFα.Comparisons were made among four time points.(5) compared score changes in cases of critical illness before and after CVVH.All data were analyzed using SPSS16.0 package.All data were expressed as mean±standard deviation((?)±s).The statistics difference in data before and after treatment were compared using t tests.For non-normal distribution data,rank sum test were used.Multiple comparisons were made by ANOVA.A post-hoc was made by LSD test.A p value of＜0.05 is considered as statistics significant.Results Evaluation of clinical outcome was done in 19 cases of children with 48 hours of CVVHD treatment.Clinical symptoms improved in 13 cases,deteriorated and resulted in death in 4 cases,treatment was given up in one case.13 children were discharged upon treatment,68.4%cure rate.(1) The level of blood urea nitrogen decreased in the four time point(the beginning of treatment,12 hr,24hr,48hr after treatment),the difference was very significant(F = 65.1,p＜0.01) before and after treatment(the beginning of the treatment of Oh and 48hr after treatment);Serum creatinine level gradually decreased comparing the four time points,very significant difference(p＜0.01),the difference was very significant(F = 70.1,p＜0.01) before and after treatment(the beginning of the treatment of Oh and 48hr after treatment);no significant difference in blood lactic acid level comparing with 12 hour,the difference was significant comparing 24 hour period(p＜0.05),the difference was very significant (F = 3.76,p＜0.05) comparing before and after treatment(the beginning of the treatment of Oh and 48hr after treatment).(2) PH level increased very significantly(p＜0.01) before and after treatment.The difference was very significant(F = 61.62,p＜0.01) compared at the beginning of treatment and 48 hours after treatment.BE blood gas value went back up significantly compared two by two in the group,the difference was very significant(p＜0.01),BE value went back up very significantly(F = 90.17,p＜0.01) compared at the start of the treatment and 48 hours after the treatment.The oxygenation index(P02/Fi02) was significantly increased(p＜0.05) compared at 12hr interval during the treatment,the difference was very significant(p＜0.01) compared at the beginning of treatment and 24hr,48 hr after the treatment.(3) The urine amount for 12 cases of children in shock increased compared at the start of treatment and 12 hours after treatment,the difference was significant(p＜0.05),and increased very significantly(p＜0.01)after 24 hours and 48 hours of treatment.The dosage of dopamine decreased in the non-normal distribution at 0,12,24,48-hour following treatment,the Chi-Square value is 47.93 using rank sum test,there was a very significant difference(p＜0.01).The Norepinephrine dosage decrease in non-normal distribution at 0,12,24,48-hour following treatment,Chi-Square value is 36.74 using rank sum test,p＜0.01 there was a very significant difference.(4) IL-8 concentration declined sharply compared at the beginning of CVVH treatment,12 hours,24 hours and 48 hours after treatment,there was a significant difference(p＜0.01,F = 86.12).For IL-10 levels,there was no significant difference(p＞0.05,F = 1.87) compared at the beginning of CVVH treatment,12 hours,24 hours and 48 hours after treatment.For the tumor necrosis factor-a(TNF-a) levels,there was significant difference(p＜0.01,F = 53.01 ) compared at the beginning of CVVH treatment,12 hours,24 hours and 48 hours after treatment.(5) Score of critical illness cases at the start of CVVH was 66.68±6.14 points and 85.12±6.39 points at CVVH 48 hour,there was a significant difference(p＜0.05).Conclusion(1) CRRT combined with conventional therapy can significantly improve the treatment of sepsis and multiple organ dysfunction syndrome in children with tissue perfusion improvement,acidosis correction,oxygenation improvement and stabilize blood pressure and reduce inotropic drugs usage.(2) CRRT is an effective treatment method for sepsis.It effectively removes body cytokines which is the possible mechanisms for the CRRT treatment of sepsis.(3) The application of CRRT in sick children is safe. |
PDF Full Text Request