Clinical Research On Effect Of Hemoperfusion Combine With High Volume Hemofiltration In Patients With Acute Respiratory Disease Syndrome

Acute respiratory distress syndrome (ARDS) is a progressive dyspnea and refractory hypoxemia of acute respiratory failure. The mortality is high. It represents as a systemic inflammatory which is caused by direct or indirect lung injury. Research shows cytokine and mediators of inflammation play an important role in systemic inflammatory. Mechanical ventilation and protective pulmonary ventilation can improve the success rate of rescue in patients with ARDS. However, it still cannot stop systemic lung injury which causes high mortality. This study focuses on the influence of hemoperfusion (HP) combined with high volume hemofiltration (HVHF) on respiratory function in patients with ARDS and prognosis.Objective:To investigate the effect of hemoperfusion (HP) combining with high volume hemofiltration (HVHF) in patients with acute respiratory distress syndrome, and to evaluate respiratory function and inflammatory factors changes after HP combing with HVHF treatments.Methods:According to random principle,40patients were divided into control group (HVHF)(n=20) and treatment group (HP+HVHF)(n=20). All patients of both groups received high volume hemofiltration and routine treatment made by medical branch association of severe acute lung injury/acute respiratory distress syndrome. HP+HVHF group also received hemoperfusion. Blood gas analysis and serum inflammatory factors measurement, PIP and CL measurement were done before,24hours and72hours after therapy. Hospitalization time in the intensive care unit, time of mechanical ventilation and the mortality in28days were observed as well.Results:Compared with control group, the time of mechanical ventilation and the time of continuous renal replacement therapy in HP+HVHF group were shorter (7.50±4.51vs.13.00±7.57,6.65±4.48vs. 8.85±4.25, P＜0.05). After72hours, patients in HP+HVHF group showed more reduction in APACHE Ⅱ score compared with control group (15.75±4.96vs.18.95±7.01, P＜0.05) as well as RI and oxygenation index (3.09±0.49vs.3.44±0.45;242.95±55.58vs.179.90±65.31, P＜0.05). PIP and CL had significant difference(P＜0.05) between24h and72h in HP+HVHF group. In control group, they improved as well after72h. TNF-a,IL-6and IL-8in HP+HVHF group all showed signification reduction compared with control group after24h and72h (P＜0.05). In HP+HVHF group, compared with24h, TNF-a,IL-6and IL-8all decreased after72h (26.30±8.27vs.18.66±5.21,30.70±10.47vs.16.04±4.92,29.27±9.03vs.20.45±6.96, P＜0.05)Conclusion:Hemoperfusion combining with high volume hemofiltration therapy can reduce the amount of inflammatory factors and improve the outcome of patients with ARDS.