Study Of Continuous Renal Replacement Therapy In Patients With Septic Shock

Background and Objective Septic Shock is,by far,the primary cause of death in Intensive Care Unit(ICU).It has high incidence,progress rapidly and high mortality.To date,there is no ideal treatment for it.Improving early diagnosis and clinical treatment of septic Shock becomes the urgent matter. Systemic inflammatory response syndrome (SIRS), is an inflammatory state of the whole body without a proven source of infection.It is a medical emergency which is caused by the cytokiner dysregulation. Continuous renal replacement therapy(CRRT) is an important morden treatment to severe patients.It has been hypothesized that CRRT may remove endotoxin and inflammatory mediators,regulate leukocyte function,blunt the exaggerated inflammatory response and improve clinical outcome.In this study,by observing the efficieny of continuous veno～venous hemofiltration(CVVH) in patients with septic Shock,we aimed to explore its mechanism,and so as to provid a theoretic basis for continued renal replacement therapy on patients with septic Shock.Methods Sixty patients with septic Shock were selected from ICU of our hospital between January 2009 and December 2010.And divided into two group,treatment goup of CRRT (30 patients) and control group (30 patients).The patient in the control group accepted routine treatment,while the CRRT group patients accepted routine treatment and continuous renal replacement therapy. (1) Blood samples were collect at four points of all patients:0 hours,24 hours,48 hours and 72 hours respectively.Each volume of 2ml blood samples were taken for conventional biochemical tests of blood urea nitrogen,creatinine,blood lactate level, total bilirubin,alanine transaminase, aspartate transaminase at different time points.(2)AT the same time,arternial blood gas analysis and Oxygenation Index(OI)was done at different time poits.(3) Heart rate(HR),mean arterial pressure(MAP) were compared at each time points.(4)Inotropic drug dosage and acute physiology and chronic health evaluationll (APACHEII) score were compared at each time points.All data were analyzed using SPSS 17.0 package.A P <0.05 is considered as statistics significant.Results After treatment, HR,MAP,Pao2,OI(Pao2/Fio2) of the CRRT group were improved more than that of the traditional group(P<0.05);Cuctic acid,Creatinine,Urea nitrogen of blood,Total bilirubin,Alanine transaminase,Aspartate transaminase of the CRRT group decreased more than that of the traditional group(P<0.05). APACHEII score of the CRRT group decreased more than that of the traditional group(P<0.05).After 48 houres,in the CRRT group,5 patients ceased using Inotropic drug,while in control group,2 patients ceased using Inotropic drug;After 72 hours, in the CRRT group,8 patients ceased using Inotropic drug,while in control group,2 patients ceased using Inotropic drug.There was a significant difference (P<0.05).Conclusion CRRT combined with conventional therapy can improve the treatment of septic Shock with tissue perfusion improvement,acidosis correction,oxygenation improvement and stabilize blood pressure and reduce inotropic drugs usage.CRRT is an effective treatment method for septic Shock.