Blood Purification In The Treatment Of Severe Sepsis

ObjectivesTo investigate the effects of continuous blood purification (CBP) for the treatment of patients with severe sepsis, as well as the right time to start.Methods46 septic patients were enrolled in a prospective and interventional study and randomly divided into two groups, CBP group(n=23) and control group(n=23). The patients in control group accepted routine treatment, while the CBP group patients accepted routine treatment and veno-venous hemofiltration(CWH). In the CBP group, the patients underwent CVVH for 72 hours, the ultrafiltrate volumes were 96L/24h and the blood flow was set 200-220ml/min, as well as the filter was replacement every 12 hours. In two groups, the APACHE II score, hemodynamics index, Blood gas analysis, fraction inspired oxygen, blood lactate, the level of c-reactive protein, procalcitonin, TNF-α,IL-1β, IL-6,IL-10 and white blood cell count, blood urea nitrogen, creatinine levels were recorded before and after treatment and compared; in addition, the various indicators in the Survival group were compared with the death group.ResultsThe APACHE II scores, the level of TNF- α,IL-1β, IL-6 and procalcitonin in thedeath group were higher than the Survival group, especially the IL-6 levels. The blood lactate levels, urea nitrogen, and creatinine levels in death group were higher than survival, but there were no statistical significance(P>0.05). As well as the levels of IL-10 and blood c-reactive protein, white blood cell count, hemodynamics and oxygen index were not significant different (P>0.05) between death and survival group. There were no difference in TNF-α, IL-1β,IL-6,IL-10, PCT, CRP level and white blood cell count, FiO2,PO2,PCO2, PH, oxygen index and blood lactate levels between CBP group and control group before treatment; The TNF-α,IL-1β, IL-6, PCT, CRP levels APACHE II scores in CBP group were obviously lower than those in control group after treatment, PO2 and oxygen index were higher (P<0.05), however, compared with control group, the IL-10 level and white blood count, FiO2, PH and blood lactate levels in CBP group were not different (P>0.05). CBP decreased the blood urea nitrogen, creatinine levels, but the hemodynamic parameters had not statistical significance (p>0.05).ConclusionsThe inflammatory levels and APACHE II scores in death group are more higer than those in survival group, TNF-α,IL-1β,IL-6,PCT level, APACH Ⅱ scores stepping up indicates patients poor outcome; and CBP has the characteristics of hemodynamic stability, and can regulate the internal environment and improve oxygenation, thus it plays a supporting role to multiple organs, and reduces the severity of the sepsis as well as improves the prognosis. The level of inflammation and APACHE Ⅱ scores help us judge the time we should start CBP treatment.