Efficacy Analysis Of Different Continuous Blood Purification Model In Children With Severe Sepsis

Objective:This study is designed to investigate effects of different Continuous Blood Purification(CBP)model treating children with severe sepsis on efficacy and prognosis.This will help clinicians choose corresponding CBP model to treat children patients with severe sepsis.Method:Paitents admitted into the Zhejiang University School of medicine in PICU children’s Hospital from January 2014 to April 2016 were enrolled.Totally 53 cases of children with severe sepsis,were randomly divided into two groups:continuous veno-venous hemofiltration(CVVH)+conventional treatment group and continuous veno-venous hemodiafiltration(CVVHDF)+ conventional treatment group.CVVH or CVVHDF was given within 6 hours after diagnosis was established.The patients were monitored 72h continuously.White blood cells(WBC)and C-reactive protein(CRP),procalcitonin(PCT)and serum inflammatory cytokines(IL-6,IL-10,TNF-a),renal function(such as SCr and BUN)were recorded before(baseline)and after treatment(24h,48h,and 72h).The indicated index changes were compared between the two groups.The 28 days survival status was followed up.Results:(1)comparison of inflammatory index:CVVH group,the WBC,CRP declined at 24h compared with baseling,but there was no statistical significance(P>0.05).When comparing with baseline,it was statistically changed at 48h(P<0.05).The inflammatory index at 72h fell significantly compared with baseline(P<0.01).PCT at 24h,48h,72h compared with before treatment all decreased significantly(P<0.05).In CVVHDF group WBC,CRP and PCT at 24h,48h was compared with before treatment,there was no statistical significance(P>0.05).However,at 72h,it was decreased significantly(P<0.05).At 72h the WBC,CRP and PCT,were significantly lower in CVVH group than in CVVHDF group(P<0.01).(2)the serum levels of inflammatory cytokines:in CVVH group,serum IL-6,IL-10,TNF-α at 24h,48h decreased significanly compared with before treatment(P<0.05),and at 72h the p value was less than 0.01.The serum levels of IL-6,IL-10,TNF-α in CVVHDF group were decreased compared with before treatment,but it was no statistical significance(P>0.05).At 72h,comparing with before treatment,it was decreased with statistical significance(P<0.05).At 72h IL-6,IL-1 were significantly declined in CVVH group than the CVVHDF group,P<0.01.At 72h,TNF-α level between the two groups was no signigificant difference(P<0.05).(3)comparison of kidney function:in CVVH group serum SCr and BUN at 24h and 48h declined comparing baseline,but there was no statistical significance(P>0.05).At it was decreased with statistical significance(P<0.05).The serum levels of SCr,BUN at 24h and 48h in CWHDF group were decreased compared with before treatment;there was statistical significance(P<0.05).At 72h it was significantly decreased compared with before treatment,(P<0.01).At 72h,serum SCr,BUN in CVVHDF group was significantly lower than the CVVH group,P<0.01.(4)the 28 day mortality rate:the 28 day mortality rate of CVVH group was 17.4%and CWHDF group was 16.7%,and there was no statistically significant differencee between the two groups(P>0.05).Conclusion:CVVH,CVVHDF models are safe and effective therapy for children with severe sepsis.For patients with obviously increased inflammatory mediators,and the kidney injury is not obvious in children with severe sepsis,choosing CVVH model may be better.For children with severe sepsis complicated with acute kidney injury,choose CVVHDF model may be better.