| Objection:To investigate the clinical efficacy and safety of continuous blood purification in patients with sepsis under different concentrations of continuous bedside blood purification to study the impact of continuous blood purification on the prognosis of patients with sepsis and discuss the use of the latest diagnosis and treatment of sepsis to determine the use of three Different doses of continuous bedside blood purification in the treatment of sepsis in the best dose to prove that continuous blood purification in the clinical treatment of sepsis an important position to improve the doctor for continuous blood purification of septic blood Confidence in the disease,reduce patient mortality and improve patient quality of life.Methods:A retrospective multicenter study was conducted with a selection period of from July 2016 to December 2017.Outpatients were admitted to hospital with 100 patients admitted to hospital with sepsis criteria,including 57 males and 43 females,a minimum of 32 years old,Maximum 76 years old.Patients were randomly divided into three groups,all patients given anti-shock,water and electrolyte imbalance correction,rehydration,anti-inflammatory treatment based on a group of patients with standard volume hemofiltration treatment 30ml/(kg?h);2 patients were given continuous high-capacity bedside hemofiltration treatment of 50 ml/(kg·h),3 patients were given continuous high-volume bedside hemofiltration treatment 70ml/(kg·h);blood flow was 250 ~ 350 ml / min.The vital signs such as respiratory rate,heart rate,mean arterial pressure and laboratory indexes of leukocyte,C-reactive protein,PLT,serum creatinine,urea,PCT,alanine aminotransferase,interleukin-6,interleukin-8 and tumor necrosis factor-α(TNF-α)levels were monitored and recorded every 6 hours in the first 3 days after treatment and recorded daily after 3 days.Before and after treatment,the changes of various indexes in each group were observed,the treatment effect was observed,the treatment and adverse reactions of each group were compared,and the survival of patients was observed at 1 month,3 months and 6 months after discharge And survival rate.Result:The results of the total treatment time of three groups with continuous bedside blood purification of different volumes were as follows: 1 group(110.87 ± 12.01)h,2 group(98.31 ± 11.89)h,3 group(79.43 ± 10.32)h,3 group superior to 2 group(F = 5.81,P = 0.009 <0.05).The heart rate of the three groups before treatment were 1 group(107.14 ± 15.32)/ min,2 group(109.47 ± 13.53)/ min,3 group(109.72 ± 11.83)times / min.After treatment,the effect of improving heart rate in group 3 was better than that of group 2 and better than group 1.Therefore,increasing blood exchange rate could improve heart rate more quickly.Before and after treatment,the changes of body temperature were statistically significant.The temperature of the 3rd group can be reduced to the normal value more quickly,followed by the second group and the first group.The changes of the three groups before and after respiration treatment were statistically significant.The improvement effect of the second and third groups was better than that of the first group,There was no significant difference between the two groups(P> 0.05).Before and after treatment,the change of mean arterial pressure did not have statistical significance.There was no significant difference in the change of leukocyte and PLT between the two groups before and after treatment(P> 0.05).Scr treatment before and after the results were different,group 3 is better than group 2 is better than group 1;three groups of patients before treatment BUN results were statistically significant,group 3 is superior to group 2 is superior to group 1(P <0.05),CPR changes in three groups before and after treatment was statistically significant,group 3 is better than group 2 is better than group 1;three groups The change of SOFA score was significant before and after treatment in patients.The scores of 2,3 groups decreased more than 1 group,but there was no obvious difference between 2 group and 3 group.The three groups of patients had a statistical significance to the changes in Il-6,Il-8,and there was no difference between the three groups in group 2 and 3(P<0.05),which are both better than group 1.The improvement of TNF-α level of the three groups was statistically significant but not increased due to the increase of the volume The curative effect of the three groups of patients after treatment showed the following: the survival rate of group 1 patients was 94.29%,the survival rate of group 2 patients was 93.94%,the survival rate of group 3 patients was 100%,no difference of P> 0.05.Conclusions:(1)The blood purification in the treatment of sepsis is safe and effective,which can be effective in patients with stable heart rate,breathing,pulse,etc.,and maintain the stability of the patient’s hemodynamics effectively,which has clinical significance.(2)The continuity of bedside blood purification can reduce the levels of serum inflammatory mediators in sepsis patients,block the inflammatory factors of the interaction of each section of inflammation and relieve patients with systemic inflammatory reaction,which has a definite therapeutic effect;(3)At infusion speed of 70 ml/(kg·h)on blood purification can quickly correct sepsis patients abnormal laboratory index,better than 50 ml/(kg·h)or 30 ml/(kg·h),so the high capacity of blood dialysis treatment can better in the treatment of sepsis patients with no serious side effects,and clinical treatment is safe and effective;(4)The continuous blood purification treatment of sepsis has not only achieved good curative effect in the treatment,but also effectively improved the survival rate of patients.(5)SOFA score method was used to determine the patient’s condition efficiently,Once conform to SOFA score≥2,the clinical effect of the treatment regimen for the treatment of sepsis was significantly improved,and the survival rate of the patients was improved,and it was worth promoting the application in the urgent and severe cases. |
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