| Objective: The incidences of sepsis and severe sepsis were increasing year by year,and the same in children.The effects of conventional medical treatments were limited,such as anti-infective treatment,symptomatic treatment,and nutrient-supporting treatment.With the maturity and standardizations of Continuous Renal Replacement Treatment,the application of CRRT was widened in sepsis and severe sepsis of children gradually,and the effect of CRRT obtained more identity.CRRT could remove redundant material such as water,urea,creatinine,inflammatory mediators poison in blood by the ways of diffusion,convection,attachment and adsorption function.The process was continuous,slow and isotonic.CRRT could clear away redundant inflammatory mediators and anti-inflammatory mediators in the blood and have full advantages of eliminating small molecules.CRRT could achieve satisfactory results and improve the prognosis of the patients with sepsis and severe sepsis[1-3].But in recent years,some scholars performed clinical study of CRRT in children with severe sepsis of multiple centers.It was shown that CRRT could not decrease inflammatory indices(WBC,CRP,PCT)in blood and prognosis significantly in patients with severe sepsis.But it could maintain the steadiness of haemodynamics,improve the oxygenation and tissue metabolism,and shorten the hospitalization of patients in PICU and hospital.At the same time,some scholars also found that CRRT couldnot reduce the mortality of children with hand-foot-and-mouth disease.The purpose of this article is to research on CRRT in patients with sepsis and severe sepsis in PICU by observing children' vital signs before CRRT and after CRRT: the changes in temperature,pulse,respirations,mean arterial pressure,and by detecting the change of creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid,white blood cell count,interleukin-6,nitric oxide synthase,calcitonin angiotensinogen,C reactive protein(CK,CKMB,SCR,BUN,Lac,WBC,IL-6,NOS,PCT,CRP).AS result,the curative effects of CRRT on children with Sepsis and Severe sepsis can be observed,and the changes and significances of related inflammatory indices before CRRT and after CRRT can be understand.The purpose is to provide a theoretical basis to CRRT on children with sepsis and severe sepsis.Methods:Sepsis and severe sepsis cases were collected who were admitted to the pediatric intensive care unit(PICU)in The Second Hospital of Hebei Medical University between June,2014 and December,2015.With the consents of pediatric patient's parents,controlled group was given conventional medical treatment,such as controlling of the primary disease,maintaining acid-base balance,supporting breath and circulation.Observed group was given medical treatment and applied CRRT.Blood purification mode was CVVHDF(continuous veno-venous hemodiafiltration),blood purification parameter settings was as follows: the blood flow velocity was(3-5 ml/kg*h),dialysate dose(30-50 ml/kg*h),anterior displacement posterior replacement(1:2),dehydrated water dose(0-2 ml/kg*h),according to the condition of patients with edema.The anticoagulant was based on blood coagulation in children.The changes of T P R MAP before and after CRRT were observed and the changes of CK,CKMB,SCR,BUN,Lac,WBC,IL-6,NOS,PCT,CRP level before and after CRRT were recorded.3ml of venous blood were separated using centrifugation at 3000r/min,centrifuge for 5 minutes,and the changes were detected of IL-6 and NOS levels in serum of patients using Elisa assay.By SPSS 21.0 statistical software for paired T test the data were analyzed.The normality test and variance index test were made.Pair T test was performed if the data is normalized,otherwise nonparametric T test was performed.If P<0.05,there was a statistically significance;if P>0.05,there was no statistically significance.Results:1 The clinical prognosis of control group and CRRT group: There were 12 cases of severe pneumonia,9 cases of severe encephalitis,3 cases of acutenecrotizing pancreatitis and 1 case of capillary leak syndrome in the 25 cases of the control group.There was 16 cases improved,9 cases died.The improvement rate was 64% and the mortality rate was 36%.There was 14 cases of severe pneumonia,8 cases of severe encephalitis,2 cases of acutenecrotizing pancreatitis and 1 case of capillary leak syndrome in the 25 cases of the CRRT group.19 cases were improved,6 cases were died,the improvement rate was 76% and the mortality rate was 24%.The data were analyzed with chi-square test.P=0.355(>0.05).The result proved that there was no significant difference between the control group and the CRRT group.2 The comparison of vital signs: The statistical value of temperature,respiration,heart rate and mean arterial pressure were t=0.262,z=-0.273,t=-0.082,z=-0.280.The value of P of temperature,respiration,heart rate and mean arterial pressure equal to 0.779,0.785,0.935,0.775(P>0.05).The results showed that the temperature,respiration,heart rate and mean arterial pressure of the two groups had no significant differences before any treatment.The statistical values of temperature,respiration,heart rate and mean arterial pressure were z=-3.969,z=-3.513,t=1.240,z=-3.612 with clinical treatment.The values of P of temperature,respiration,heart rate and mean arterial pressure equal to 0.000,0.000,0.020,0.000(P<0.05).The results showed that the indicators were improved by clinical treatment.The statistical value of temperature,respiration,heart rate and mean arterial pressure were t=9.698,t=8.227,t=5.717,t=6.727 with CRRT treatment.The values of P of temperature,respiration,heart rate and mean arterial pressure equal to 0.000,0.000,0.000,0.000(P<0.05).The results showed that the indicators were improved by CRRT treatment.The compared control group with the CRRT group after treatment showed that the statistical value of temperature,respiration,heart rate and mean arterial pressure were t=4.23,z=-3.735,z=-4.272,z=-3.730.The value of P of temperature,respiration,heart rate and mean arterial pressure equal to 0.000,0.000,0.000,0.000(P<0.05).The result proved that the effect of CRRT was more significant.3 The comparison of viscera function and tissue metabolism: The results showed that creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid of the two groups had no significant difference before conventional treatment and CRRT treatment,P>0.05.The statistical value of creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid was t=3.047,z=-3.305,t=2.864,z=-2.591,z=-1.972,with clinical treatment.The values of P of creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid equal to0.004,0.001,0.006,0.010,0.049(P<0.05).The results showed that the indicators were improved by clinical treatment.The statistical value of creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid was z=-3.891,z=-0.670,z=-6.003,z=-6.031,z=-6.032 with CRRT treatment.The value of P of temperature,respiration,heart rate and mean arterial pressure equal to 0.000,0.000,0.000,0.000(P<0.05).The results showed that the indicators were improved by CRRT treatment.Compariron bewteen the control group and the CRRT group after treatment showed that the statistical value of creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid was z=-3.387,z=-5.540,z=-5.878,z=-5.796,z=-5.917 The value of P of temperature,respiration,heart rate and mean arterial pressure equal to 0.001,0.000,0.000,0.000(P<0.05).The result proved that the effect of CRRT was more significant.4 The changes of inflammatory indexes: According to the results,the white blood cell count,interleukin 6,and nitric oxide synthase,c-reactive protein and procalcitonin had no statistical difference before conventional treatment and CRRT treatment of two groups of patients,P>0.05.The statistical value of the white blood cell count,nitric oxide synthase,interleukin 6,procalcitonin and c-reactive protein were z=-0.323,z=-0.592,z=-2.455,z=-3.162,t=2.085 with clinical treatment.The values of P of the white blood cell count,nitric oxide synthase,interleukin 6,procalcitonin and c-reactive protein equal to 0.747,0.055,0.014,0.002,0.043.The results showed that the white blood cell and nitric oxide synthase have no statistical difference,but.interleukin 6,procalcitonin and c-reactive protein have statistical difference.The statistical value of the white blood cell count,nitric oxide synthase,interleukin 6,procalcitonin and c-reactive protein was t=0.835,z=-1.737,z=-5.385,z=-4.877,z=-3.338 with CRRT treatment.The values of P of the white blood cell count,nitric oxide synthase,interleukin 6,procalcitonin and c-reactive protein were 0.408,0.082,0.000,0.000,0.001.The results showed that the white blood cell and nitric oxide synthase had no statistical difference,but interleukin 6,procalcitonin and c-reactive protein had statistical difference.Comparion between the control group and the CRRT group after treatment showed that the statistical value of the white blood cell count,nitric oxide synthase,interleukin 6,procalcitonin and c-reactive protein were z=-0.42,z=-4.017,z=-1.941,z=-2.261,z=-3.716.The value of P of the white blood cell count,nitric oxide synthase,interleukin 6,procalcitonin and c-reactive protein was 0.675,0.000,0.052,0.024,0.000.The result proved that the white blood cell counts could not be improved by CRRT,but the others all were impoved significantly.Conclusion:1 The clinical prognosis has no significant difference between the control group and the continuous renal replacement treatment group.2 The temperature,respiration,heart rate,mean arterial pressure of children with sepsis and severe sepsis are more stable in CRRT than group.3 The values of creatine kinase,creatine kinase isoenzyme,serum creatinine,blood urea nitrogen,lactic acid of children more improve in CRRT group than the the control group.4 Interleukin 6,procalcitonin nitric oxide synthase and c-reactive protein can be reduced more significantly in CRRT group.But CRRT can not reduce the white blood cell count significantly.5 In this study,there are no technical complications such as blood clotting of extracorporeal circulation,air embolism,and clinical complications such as bleeding,blood clots,low temperature and losing nutrition. |
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