Treatment Of Continuous Blood Purification And Its Effect On Immune System In Patients With MODS

In clinical conditions, we studied the treatment of continuous blood purification and its effect on immune system in patients with multiple organs dysfunction syndrome(MODS). The main work contained two parts as follows: 1. Treatment of continuous blood purification in patients with MODSAim: To investigate the treatment of continuous blood purification (CBP) in patients with MODS. Methods: Twenty patients with MODS in intensive care unit of our hospital were scheduled for the treatment of CBP. Thirteen of these patients are male, and seven female. Mean age was years old. All patients were satisfied the criteria of MODS and ARDS. Except for routine monitors, heart rate(HR), mean arterial pressure (MAP) and central venous pressure(CVP) was monitored. A double trunk catheter was put into the right femoral vein and the CBP was done with the Diapact CRRT. The replacement liquid was put in by the pattern of pre-dilution. The flow was from 3000ml to 4000ml per hour. The blood flow was from 200ml to 300ml per minute. The volume of ultrafiltration depended on the volume of treatment and the volume of physiological need. Treatments included the mangement of primary disease and maintenance of main organ or system function. The HR, MAP, CVP, PaO2, PaCO2,PaO2/FiO2, dynamic com pliance (Cdyn), resistance of airway(Raw), blood biochemical markers including electrolytes, urea nitrogen and creatine, were recorded or measured at Oh, 2h, 4h, 6h following the CBP and 6h post-CBP. Results: No significant difference was found in the parameters of hemodynamics except for HR significant decrease following CBP. There was no significant difference in pH, PaCO2 after CBP compared with those of pre-CBP But PaO2, PaO2/FiO2, Cdyn incresed significantly and Raw decreased significantly following CBP. No significant difference was found in blood Na+, Cl-, Glu after CBP compared with those of pre-CBP, But BUN, Scr and serum K+ levels decresed significantly following CBP. Conclusion: CBP could impove the respiratory function and the blood biochemical markers including BUN Scr and serum K+ with little harmful effect on hemodynamics in patients with MODS.2. Effect of continuous blood purification on immune system in patients with MODSAim: To investigate the effect of continuous blood purification (CBP) on immune system in patients with MODS. Methods: Patients and method of CBP were the same with those of part one. On the mornings of pre-CBP, CBP 1d, CBP 3d, CBP 5d, CBP 7d, we measured the concen trations of plasma cytokines by ELISA and the levels of plasma CRP, SAA by immunal nephelometry. At the same time, the cell percent of lymphocytesubsets and the expression of monocyte HLA-DR was detected by flow cytomery analysis. Results: Survival group: The plasma concentra tions of TNF ,IL , IL-2R and IL-8 decreased gradually with the marked reduction following CBP. There was no significant difference in the plasma concentration of IL-6, IL-4 and IL-10 at any time following CBP compared with those of pre-CBP. The cell percents of CD3+, CD4+, and ratio of CD4+/CD8+ all increased, but the cell percent of CD8+ decreased gradually following CBP. There were decreased trends in the plasma concentrations of CRP and SAA. The count of monocyte and HLA-DR expression of peripheral blood both increased. Non-survival group: There was no significant difference in the plasma concentration of TNF- a , IL-1 IL-2R, IL-8, IL-6 and IL-4 at any time following CBP compared with those of pre-CBP. The plasma concentrations of IL-10 decreased at CBP 1d and then increased. There was no difference compared with those of pre-CBP, although the cell percent of CD3+, CD4+ and ratio of CD4+/CD8+ all increased, and that of CD8+ decreased gradually following CBP. The levels of plasma CRP and SAA decreased gradually. There was a significant difference in the plasma concentrations of CRP at CBP Id and CBP 3d compared with those of pre-CBP. There was a significant difference in the plasma concentration of SAA at CBP Id compared with that of pre-CBP. No significant difference c...