| BackgroundSeptic shock combined with acute respiratory distress syndrome（ARDS）is one of the main causes of death in intensive care unit（ICU）patients.The pathogenesis is that the uncontrolled inflammatory response leads to an imbalance in the body’s inflammatory/anti-inflammatory mechanism,resulting in tissue damage and multi-organ failure.Therefore,controlling excessive inflammatory response is the key to curbing the progress of the disease.In recent years,blood purification technology has gradually attracted attention to removing cytokine.Due to different blood purification patterns,its curative effect is also different.Studies have shown that coupled plasma filtration adsorption（CPFA）is better than continuous veno-venous hemofiltration（CVVH）can better remove medium and large molecules cytokine.However,at present,there are few clinical studies on CPFA in patients of septic shock combined with ARDS,its safety and efficacy need to be further demonstrated.Therefore,this study explores the application value of CPFA in patients of septic shock combined with ARDS and provides a reference for the clinical treatment.ObjectivesCompare the clinical effects of CPFA and CVVH for the treatment of septic shock combined with ARDS,To explore the application value of CPFA in patients of septic shock combined with ARDS and provide a theoretical and practical basis for the clinical treatment of septic shock combined with ARDS.MethodsThrough a retrospective analysis of 187 patients with septic shock combined with ARDS admitted to the Respiratory Intensive Care Unit（RICU）of Zhengzhou Central Hospital affiliated to Zhengzhou University from January 2018 to December 2020.A total of 60 cases were included in accordance with the inclusion,exclusion criteria and exclusion of patients who have not undergone blood purification treatment.According to the blood purification patterns used,they are divided into two groups:30 cases in the CVVH group and 30 cases in the CPFA group.Collect general clinical data of patients.Collect and compare:（1）inflammatory indicators[C-reactive protein（CRP）,procalcitonin（PCT）,interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,interleukin-10（IL-10）];（2）hemodynamics indicators[arterial blood lactic acid（LAC）,mean arterial pressure（MAP）,heart rate（HR）and use of norepinephrine（NE）];（3）cellular immune function indicators[lymphocyte（LY）count,T-lymphocytes subgroups（CD3+,CD4+,CD8+）count and ratio of CD4+to CD8+];（4）organ function indicators[oxygenation index,alanine transaminase（ALT）,aspartate transaminase（AST）,total bilirubin（TBIL）,creatinine（Cr）,blood urea nitrogen（BUN）,lactate dehydrogenase（LDH）,creatine kinase（CK）];（5）coagulation indicators[Prothrombin time（PT）,activated partial thromboplastin time（APTT）,thrombin time（TT）and D-dimer];（6）blood composition[red blood cells（RBC）,white blood cells（WBC）and platelets（PLT）]at various points before and after treatment.Sequential organ failure assessment（SOFA）score,acute physiology and chronic health evaluationⅡ（APACHEⅡ）score were performed at various points before and after treatment;collect and compare mechanical ventilation time in RICU,hospitalization time of RICU and calculate the 28-day survival rate.The data are processed by SPSS 20.0 software.The measurement data at different time points before and after treatment in the group are compared with the variance analysis of repeated measurement data.The measurement data at the same time point between the group are compared with independent sample t test,and the inter-group count data are compared withx~2test.Results1.General clinical data:There was no significant difference in gender,age distribution,location of infection,underlying diseases,APACHEⅡscore and SOFA score in the two groups before treatment（all P>0.05）.2.The serum cytokine:The levels of serum PCT,CRP,IL-6,IL-10 and TNF-αshowed a downward trend on the first,second and third day after treatment of CVVH or CPFA（all P<0.001）,the difference was statistically significant.In the CPFA group,the reduction of serum IL-6,IL-10,and TNF-αwere greater than those in CVVH group（all P<0.05）,the difference was statistically significant.Comparison between group CPFA and CVVH,the level of serum IL-10 was significantly lower in group CPFA on the 1st,2nd,3rd day of treatment than in CVVH group（all P<0.05）,the difference was statistically significant.The levels of serum IL-6 and TNF-αwere significantly lower in group CPFA on the 1st,2nd day of treatment than in group CVVH（all P<0.05）,the difference was statistically significant.There were no statistical differences in the levels of serum CRP and PCT between the two groups（all P>0.05）.3.The hemodynamic parameters:The level of MAP showed an upward trend and HR,LAC showed a downward trend on the 1st,2nd,3rd,7th day after treatment of CVVH or CPFA（all P<0.001）,the difference was statistically significant.Comparison between group CPFA and CVVH,the level of LAC in group CPFA was significantly lower than CVVH in the second day of treatment（P<0.05）,the difference was statistically significant.The dose and time of NE use were shorten in group CPFA compared with group CVVH（all P<0.05）,the difference was statistically significant.There were no statistical differences between the two groups in the levels of MAP and HR（P>0.05）.4.The cellular immune function indicators:The levels of LY,T-lymphocytes subgroups（CD3+,CD4+,CD8+）showed an upward trend on the 3rd,7th day after treatment of CVVH or CPFA（all P<0.001）,the difference was statistically significant.The increment of LY,T-lymphocytes subgroups in group CPFA is greater than those in group CVVH on the 3rd,7th day after treatment（all P<0.05）,the difference was statistically significant.The CD4+/CD8+on the 3rd,7th day after treatment in CVVH group showed a downward trend and in group CPFA showed an upward trend（all P<0.05）,the difference was statistically significant.Comparison between group CPFA and CVVH,the levels of LY,T-lymphocytes subgroups in group CPFA were higher than group CVVH in the 7th day（all P<0.05）,the difference was statistically significant.There were no statistical differences between the two groups of CD4+/CD8+before and after treatment（all P>0.05）.5.Organ function indicators:The level of oxygenation index showed an upward trend on the 3rd and 7th day after treatment of CVVH or CPFA（P<0.001）,the difference was statistically significant.The oxygenation index in group CPFA was higher than group CVVH in the 3rd day（P<0.05）,the difference was statistically significant.In group CVVH,the levels of ALT and AST increased in the 3rd day,then decreased in the 7th day after treatment,the level of TBIL showed a downward trend on the 3rd and 7th day after treatment（all P<0.001）,the difference was statistically significant.In group CPFA,the levels of ALT,AST and TBIL showed a downward trend on the 3rd and 7th day after treatment（all P<0.001）,the difference was statistically significant.The levels of ALT and AST decreased significantly in group CPFA in the 3rd and 7th day after treatment than group CVVH（all P<0.05）,the difference was statistically significant.There was no significant difference in TBIL between the two groups before and after treatment（P>0.05）.The level of Cr and BUN showed a downward trend on the 3rd and 7th day after treatment of CVVH or CPFA（all P<0.001）,the difference was statistically significant.The level of BUN in group CPFA was lower than group CVVH in the 7td day（P<0.05）,the difference was statistically significant.There was no significant difference in Cr between the two groups before and after treatment（P>0.05）.The level of LDH and CK showed a downward trend on the 3rd and 7th day after treatment of CVVH or CPFA（all P<0.001）,the differences was statistically significant.The level of LDH and CK in group CPFA was lower than group CVVH in the 7td day（all P<0.05）,the difference was statistically significant.6.The coagulation function:The levels of PT,APTT,TT and D-dimer showed a downward trend on the 3rd and 7th day after treatment of CVVH or CPFA（all P<0.05）,the difference was statistically significant.The levels of TT and D-dimer decreased significantly in group CPFA in the 7th day after treatment than group CVVH（all P<0.05）,the difference was statistically significant.There were no significant differences between the two groups in PT and APTT before and after treatment（all P>0.05）.7.The blood formed element:There were no significant differences in the levels of blood RBC,WBC,WBC and PLT before and after treatment（all P>0.05）,and there were also no significant differences in those between the two groups（all P>0.05）.8.Prognosis:SOFA score and APACHEⅡscore showed downward trend on the 3rd and 7th day after treatment of CVVH or CPFA（all P<0.001）,the difference was statistically significant.APACHEⅡscore decreased significantly in group CPFA in the 7th day after treatment than group CVVH（P<0.05）,the difference was statistically significant.There was no significant difference in SOFA score between the two groups before and after treatment（all P>0.05）.Comparison between group CPFA and CVVH,the mechanical ventilation time in RICU were shorten in group CPFA compared with group CVVH（P<0.05）,the difference was statistically significant.There was no statistical difference in hospitalization time of RICU between the two groups（P>0.05）.The 28 days survival rate of CPFA group and CVVH group was 66.67%（20/30）and 60.00%（18/30）,respectively,there was no statistically significant in the survival rate of 28 days between group CPFA and group CVVH（x~2=0.447,P>0.05）.ConclusionsIn patients of septic shock combined with ARDS,both CVVH and CPFA therapies have certain clinical efficacy,meanwhile,they have better security which have no influence on the blood cell component.However,CPFA is better than CVVH in removing inflammatory mediators,stabilizing hemodynamics,regulating cellular immune function,improving organ and coagulation function,reducing APACHEⅡscore and shortening the mechanical ventilation time.CPFA has better clinical treatment prospects. |
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