The Clinical Research On The Therapy Of Hydroxy Ethyl Starch And Continuous Blood Purification For Capillary Leak Syndrome

Background and ObjectiveCapillary leak syndrome (CLS) is a group of syndromes of hypoproteinemia,hypovolemic shock and acute renal ischemia in clinical manifestations because of theinjury of capillary endothelial cells, increased vascular permeability with a largenumber of small molecule plasma proteins leaking into the clearance of tissues under avariety of pathogenic factors. The treatment of the CLS mainly includes in controllingthe primary disease, liquid treatment, improving the capillary permeability, ensuringoxygen supply for organization, promoting tissue clearance water discharge to relieveedema presently. But there is not a kind of treatment which is the accepted effectivecurrently. The third-generation hydroxyethyl starch (HES) has good effect on increasingcapacity, maintaining hemodynamic stability, and "plugging loopholes" to a certainextent. It is metabolized and discharged easily, has little of side effects. Continuousblood purification (CBP) can remove inflammatory mediators effectively, improvepulmonary gas exchange, stabilize hemodynamics, control azotemia, relieve severefluid overload that it is caused by infusing a lot of artificial crystal and colloid, beconvenient for nutritional support, stabilize internal environment and be conducive tothe treatment of primary disease. Therefore, the combination of the third-generationHES and CBP can be used for the treatment of CLS. But the curative effect and theinfluence on prognosis still have bigger dispute now. This study will explore thecurative effects of the third-generation hydroxyethyl starch and continuous bloodpurification to CLS and their influence on the prognosis. MethodsThis study analyzed retrospectively the clinical data of patients with critically ill inintensive care unit (ICU) of our hospital in July2008to October2012. According tothe different treatment measures,101cases with CLS in intensive care unit (ICU) weredivided into: the using HES group and non using HES group, the using CBP group andnon using CBP group, the using HES combined CBP group and no using HES or CBPgroup. According to the prognosis, they were divided into the survival group and deathgroup. The clinical data of patients with CLS were recorded when CLS occurred. Andthe second generation of acute physiology and chronic health evaluation (APACHEⅡ), the second generation of simplified acute physiology score (SAPS Ⅱ), multipleorgan dysfunction syndrome (MODS) score were calculated. The clinical effect ofHES and CBP, and their influence to the prognosis were discussed. Data was disposedby SPSS13.0statistical software. Data was represented with the mean±standarddeviation (x±s). The measurement data between the two groups were analyzed with ttest, analysis of variance and rank sum test. The counting data were analyzed bychi-square test. The multiple factors analysis was using Logistic regression analysis. P<0.05represents that the difference is significant statistically.Results1. The cure/recovery rate of the patients with CLS was66.34%, the mortality was17.82%, the discharge rate and no recovery was15.84%. The length of stay was(29.17±22.50) d. The length of attacking to appearing CLS was (4.80±4.23) d.2. The mortality was decreased in the using HES group (P <0.05).3. Compared with the non using CBP group, MODS score of the patients in CBP groupwas higher (P <0.05), the mortality was not decreased, and the length of stay was notprolonged (P>0.05).4. Compared with the no using HES or CBP group, the patients with oliguria orhydrothorax and ascite were more in the using HES combined CBP group (P <0.01), and the mortality was not increased (P>0.05).5. Compared with the survival group, APACHE Ⅱ score, SAPS Ⅱ score and MODSscore were higher in the death group (P <0.01).6. The Logistic multivariate regression analysis found that the high of APACHE Ⅱscore, glutamate pyruvate transaminase and/or blood urea nitrogen was the risk factorsof death in the patients with CLS.Conclusions1. HES can decrease the mortality of the patients with CLS.2. HES combined CBP therapy or single CBP therapy can not decrease the mortality ofthe patients with CLS, but it can gain time for curing the primary disease.3. APACHE Ⅱ score, glutamate pyruvate transaminase and/or urea nitrogen are therisk factors of death in the patients with CLS.