Effect Of Continuous Blood Purification On Prognosis And Endothelial Cell Function In Patients With Severe Sepsis

[Objective]The aim of the study was to investigate the effect of continuous blood purification(CBP) in patients with severe sepsis and evaluate the change of endothelial cell dysfunction in patients with severe sepsis during CBP therapy.[Methods] 45 patients with sever sepsis were enrolled and randomly divided into two groups, control group (n=22) and CBPgroup (n=23). The patients in control group accepted routine treatment, while the CBP group patients accepted routine treatment and continuous veno-venous hemofiltration (CVVH) for 72h, the ultrafiltrate volumes were 40mL/kg/h. In two groups, the APACHEII score, death rate in 28 days and mean arterial blood (MAP) were recorded before and after treatment. Blood gas analysis, lactate and biochemical examinations were measure at 0h, 24h and 72h during CVVH therapy. Blood samples were taken from the patients at the same time. Activated protein C, soluble intercellular adhesion molecule 1 and von Willebrand factor were measured by ELISA.[Results]1,Comparing between the two groups, the day of ICU and using ventilator of CBP group was shorter (P=0.033, P=0.039), death rate in 28 days was lower (P=0.046).2,After therapy, CBP group have much more reduce in the APACHEII score compared with control group (P=0.028).3,The MAP of CBP group was higher at 72h than 0h (P=0.007); CBP group was associated with a greater reduction in norepinephrine requirement than control group(P=0.036).4,After 72h of treament, CBP group have lower lactic acid compared with control group (P=0.001) and the have a higher oxygenation index compared with 0h (P=0.001).5,The control group has no significant changes in BUN, ALT and AST after therpy. There were significant reductions in BUN, ALT and AST of CBP group(P=0.033; P=0.039; P=0.009)。6,Patients of control group have few change in Cytokines.APC of CBP group increased at 72h (P=0.007). ICAM-1 and vWF of CBP group respectively decreased at 72h (P=0.029; P=0.012).7,Patients died in 28 days have few change of sICAM-1, vWF and APC, while, patients live after 28 days have much more reduce in sICAM-1 and vWF(P=0.019; P=0.025). The APC in patients live after 28 days has a increase after treatment (P=0.006).[Conclusion]1. CBP therapy can reduces the severity of the severe sepsis as well as improve the outcome of severe sepsis patients.2,CBP therapy can improve oxygenation and play a supporting role to multiple organs.3. CBP treatment can protect endothelial cell function and improve dysfunction.