The Cooperative Effect Of High Volume Hemofiltration Combined With Hemoperfusion On The Treatment Of Acute Respiratory Distress Syndrome

Objective: Acute respiratory distress syndrome(ARDS)is a kind of acute respiratory failure with high incidence,characterized by refractory hypoxemia and progressive dyspnea,the main reasons for this disease are indirectly or directly lung injury caused by the out control of systemic inflammatory response.ARDS has high incidence,the main factor that causes the disease to be a systemic inflammatory response,which is caused by indirect or direct lung injury.Many inflammatory mediators and cytokines play an important role in the occurrence,development and systemic inflammatory response of ARDS.At present,the use of mechanical ventilation and protective lung ventilation strategy should be applied to ARDS.Although the success rate of rescue can be improved,no effective treatment has been found to terminate the inflammatory lung injury in ARDS.Although the use of the ECMO,the equivalent of lung replacement therapy to patients for the time,but we hypothesize that if we can use high volume hemofiltration combined with hemoperfusion at the same time in the treatment of acute respiratory distress syndrome,which can better and more efficient removal of inflammatory mediators,interdict inflammatorycascade,and will be more conducive to the lung recovery and improvement in lung function.Although the current guidelines do not recommend,but maybe possible to provide a better means and new direction for the future treatment of ARDS,and can also reduce the use of ECMO time,greatly reduce the cost.The purpose of this study was to demonstrate the cooperative effect of high volume blood filtration combined with hemoperfusion on the treatment of acute respiratory distress syndrome.Methods: Retrospective analysis of 64 patients with acute respiratory distress syndrome from January 2016 to January2017.The treatment was divided into two groups,one for the study group(32cases)and the other for the control group(32 cases).Patients in control group were treated with high volume hemofiltration(HVHF),while those in study group were given high volume hemofiltration combined with hemoperfusion(HP).Pulmonary inflammatory cytokine removal effect compliance,the airway peak pressure,oxygenation,respiratory index,APACHE Ⅱ score and the number of HVHF,mechanical ventilation time and ICU length of hospital stay,28 d case fatality rate were compare in two groups before and after treatment.Results: There was no difference in the levels of IL-8,IL-6 and TNF-a in the two groups before the treatment(P>0.05).Compared with pretreatment,the levels of IL-8,IL-6 and TNF-a in both groups significantly decreased afterthe treatment(P<0.05).Compared with the control group,the decreased levels of IL-8,IL-6 and TNF-a were better in the study group(P <0.05).There was no difference in lung compliance and airway peak pressure between the twogroups before the treatment(P>0.05).Compared with pretreatment,lung compliance and airway peak pressure were significantly improved in both groups(P<0.05).Compared with the control group,pulmonary compliance and airway peak pressure were significantly improved in the study group after the treatment(P<0.05).Oxygenation status,respiratory index,APACHE Ⅱ score no difference between the two groups before the treatment(P>0.05);Compared with pretreatment,oxygenation status,respiratory index,APACHE Ⅱ score were significantly improved in both groups(P<0.05);Compared with the control group,treatment group patients after oxygenation status,respiratory index,APACHE Ⅱ score were significantly improved in the study group after the treatment(P<0.05).Compared with the control group,the number of HVHF and mechanical ventilation time was less in the study group(P<0.05).There was no difference in the ICU duration and mortality between the two groups(P>0.05).Conclusion:High volume hemofiltration combined with hemoperfusion have cooperative effect on the treatment of acute respiratory distress syndrome.The technical characteristics of this combination therapy are mainly to reduce intrapulmonary shunt,remove of pulmonary interstitial water and some cytokines,and also terminate the inflammatory cascade reaction,promote cell carrying capacity,improve microcirculation,and improve tissue oxygen utilization.At the same time,high volume hemofiltration combined with hemoperfusion can effectively remove inflammatory cytokines,make a significant reduction in the peak concentration of cytokines which affect lungfunction,and can improve disease and prognosis,shorten the time of mechanical ventilation and the number of HVHF,reduce medical costs,and the combined way is simple,high maneuverability,can reduce patients’ economic burden,is worthy of popularization and application.