Effects Of Different Doses In Continuous Blood Purification On Outcomes Of Critically Ill Patients In The Elderly

Objective: To observe the effects of different doses in continuous bloodpurification（CBP） on outcomes of critically ill patients in the elderly.Methods:168cases of critically ill patients were analyzed retrospectivelywho stayed in our intensive care unit from Jan.2008to Jun.2011.168patientstreated with routine treatment and different doses of8¹2h/d CBP. Patients wereassigned the dose at2³L/h（Group A， n=13）,4⁵L/h（Group B, n=63）,6⁷L/h（Group C, n=49） or8⁹L/h（Group D, n=43）. Clinical status prior to CBPwere collected（sex，age, complications, medical diseases, nonrenal organ failureetc）. APACHEâ…¡ score was computed. There blood urea nitrogen（BUN）,serum creatinine（Cr）, mean arterial pressure（MAP）, pH value, oxygenationindex（PO₂/FiO₂） and APACHEâ…¡ score were recorded both at pre-treatmentand post-treatment. Technique and method of CBP（modality，dosage，membraneof hemofilter used in CBP， vascular access of CBP， and category ofanticoagulant）were recorded. Patients were observed the72h survival rates andthe end outcomes. Results: Before the treatment, all groups were similar in sex, age,presence of diabetes or sepsis, medical diseases, the number of nonrenal organfailure, BUN, Cr, MAP, pH value, PO₂/FiO₂and APACHEâ…¡ score （P＞0.05）.After treatment in groups B, C and D, BUN and Cr decreased（P＜0.05）,PO₂/FiO₂increased（P＜0.05）. The changes of MAP in all groups were notstatistically significant（P＞0.05）. In four groups after treatment, pH valueincreased, APACHEâ…¡ score decreased （P＜0.05）.72h survival rate in group Bwas higher than group A and group D, group C was higher than group A andgroup D（P＜0.05），and similarly in group B and group C（P＞0.05）. The endpoint outcomes were not statistically significant among all groups（P＞0.05）.Logistic regression analysis found that APACHEâ…¡ score in pre-treatment wererelated with poor outcomes.Conclusions: The doses≥4L/h of8¹2h/d CVVH could decrease thelevel of BUN and Cr, improve oxygenation index.8¹2h/d CVVH could correctacidosis, keep MAP stability and decrease APACHEâ…¡ score. With the increaseof the dose，short-term survival rate increased, reached the peak in4⁷L/h，decreased in8⁹L/h. The end point outcomes were not related with the doses of8¹2h/d CVVH （P=0.214）.