Clinical Research On Application Of Hemoperfusion Combined With Hemofiltration In Posttraumatic Sepsis

【Objective】To evaluate the clinical significance of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)in treating trauma patients with sepsis.【Method】Sixty-three trauma patients with sepsis admitted to the Department of Trauma Surgery,Tongji Hospital,from June 2017 to December 2018 were enrolled in this study.Patients were randomly divided into two groups,with 31 cases in the treatment group(HP+CVVH group),and 32 cases in the control group(CVVH group).All of them were received conventional treatment according to the 2016 International Guidelines for the Diagnosis and Treatment of Sepsis,and surgery is performed when appropriate.The treatment group was treated with HP tandem CVVH in addition,and the control group was treated with CVVH.Levels of inflammatory mediators(IL-1β,IL-2R,IL-6,IL-8,IL-10,TNF-α,PCT and CRP)were observed before treatment(0h)and at 24,48 and 72 hours after treatment,hemodynamics and tissue perfusion indicators(HR,MAP,RR,OI,and Lac),disease scores(APACHE II and SOFA scores),and platelet count.Clinical outcomes 28 days after treatment were observed.【Result】1.Comparison within the group: Serum levels of inflammatory mediators were declined gradually after blood purification treatment in two groups,hemodynamics and tissue perfusion indicators improved gradually,APACHE II score and SOFA score were gradually lowered.The levels of IL-2R,IL-6,IL-8,TNF-α,PCT and CRP decreased obviously after treating for 24 hours(P<0.05),IL-1β decreased significantly after 48 hours(P<0.05);HR,MAP,RR,OI and Lac,APACHEII and SOFA scores were significantly improved after 48 hours(P<0.05).There was no significant difference in IL-10 levels before and after treatment.2.Comparison between groups: Serum levels of inflammatory mediators in the treatment group decreased more obviously after treatment,and the disease improved more significantly.At 48 and 72 hours,the levels of IL-1β,IL-2R,IL-6,IL-8,TNF-α,PCT and CRP in the treatment group,HR and RR were lower than those in the control group(P<0.05),MAP and OI were higher than the control group(P<0.05);The Lac,APACHEII and SOFA scores were lower than the control group at 72 hours after treatment(P<0.05).3.The platelet count of the treatment group was significantly lower than that before at 24 and 72 hours(P<0.05),and lower than that in the control group at 72 hours(P<0.05).There was no significant change in the control group of platelet count after treatment.4.The 28-day mortality rate of the treatment group and the control group were 19.4% and 21.9%,respectively.The difference was not statistically significant,but both of them were lower than the mortality rate of the trauma patients with sepsis received conventional treated in our department(26.6%).【Conclusion】HP combined with CVVH treatment can effectively remove inflammatory mediators,relieve the inflammation,improve hemodynamics,and improve tissue and organ perfusion for trauma patients with sepsis,and ultimately improve the condition.It is a safe and effective blood purification mode although HP treatment has some damage to platelets.Blood purification appears to reduce 28-day mortality and improve prognosis of trauma patients with sepsis.