Continuous Blood Purification Treatment Research Articles

Effects of Saffron Yellow A as an Extract of Saffron on the Recovery Treatment and Organ Function of Patients with Sepsis

This research was aimed to investigate the effects of saffron yellow A (SESYA), an extract of saffron, in combination with continuous blood purification on serum factors, coagulation function, rehabilitation progress, and organ function of intensive care (ICU) patients with sepsis. Seventy ICU patients with sepsis and admitted to hospital were assigned to control group (group C), which received continuous blood purification treatment, and treatment group (group T), which received continuous blood purification combined with SESYA treatment. Serum factors (lactic acid (LAC), procalcitonin (PCT), C-reactive protein (CRP)), coagulation-related indicators (activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count (PLT)), quality of life (QoL), prognosis-related indicators [Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II)], and changes in major organ function indicators (liver function: alanine aminotransferase (ALT), aspartate aminotransferase (AST); renal function: creatinine (Cr), blood urea nitrogen (BUN); cardiac function: lactate dehydrogenase (LDH), creatine kinase (CK)) were compared before and after treatment in both groups. The purity of the prepared SESYA exceeded 90%. The serum factors and coagulation function indicators demonstrated inconsiderable differences between groups before treatment (P < 05). Relative to group C, group T showed a marked decrease in serum functional indicators and major coagulation function indicators (P < 05). After treatment, group T exhibited improved QoL scores and decreased prognosis-related indicator scores versus group C (P < 05). The levels of organ function indicators in two groups greatly decreased after treatment (P < 05), with group T showing notably greater improvement compared to group C (P < 05). These findings demonstrate that SESYA, an extract of saffron, can remarkably reduce serum factor levels, improve coagulation function, enhance QoL, and alleviate sepsis-induced damage to vital organs.

Effect of continuous blood purification on immunity and endothelial cell function in patients with sepsis

To explore the effect of continuous blood purification (CBP) on the immunity and endothelial cell function of patients with sepsis. A prospective study was conducted. The patients aged ≥ 18 years old and meeting the diagnostic criteria of sepsis admitted to the department of critical care medicine of Binzhou Medical University Hospital from March 2019 to October 2020 were selected as the research subjects, and the patients were divided into standard treatment group and CBP treatment group according to random number table method. Both groups were given standard treatment including initial fluid resuscitation, infection source control and antibiotics according to the 2016 international guidelines for the management of sepsis and septic shock. CBP treatment group was additionally given continuous veno-venous hemofiltration (CVVH) at a dose of 25-30 mL×kg-1×h-1 and blood flow rate of 150-200 mL/min for more than 20 hours a day for 3 days. The clinical data of patients including blood lactic acid (Lac), procalcitonin (PCT), lymphocyte count (LYM), acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score were recorded before treatment and 1 day and 3 days after treatment. At the same time, the venous blood was collected, and the immune function related indexes [interleukins (IL-4, IL-7), programmed death receptor-1 (PD-1), programmed death ligand-1 (PD-L1), interferon-γ (IFN-γ)] and endothelial cell injury related markers [soluble thrombomodulin (sTM), angiopoietin-2 (Ang-2), von Willebrand factor (vWF), heparan sulfate (HS), syndecan-1 (SDC-1)] levels in serum were determined by enzyme-linked immunosorbent assay (ELISA). The length of intensive care unit (ICU) stay of patients in the two groups was recorded, and the outcomes of patients in the two groups were followed up for 28 days. Finally, 20 patients were enrolled in the standard treatment group, and 19 patients were enrolled in the CBP treatment group. There were no significant differences in gender, age and infection site between the two groups. The length of ICU stay in the standard treatment group was (10±5) days, and 5 patients died and 15 patients survived after 28 days. The length of ICU stay in the CBP treatment group was (9±4) days, and 8 patients died and 11 patients survived after 28 days. There were no significant differences in the length of ICU stay and number of patients who died within 28 days between the two groups (both P > 0.05). There were no significant differences in the Lac, PCT, LYM, APACHE II score, SOFA score and immune function and endothelial cell injury related indexes before treatment and 1 day after treatment between the two groups. After 3 days of treatment, the Lac, PCT, APACHE II score and SOFA score of the CBP treatment group were significantly lower than those before treatment, and pro-inflammatory and anti-inflammatory cytokines such as IFN-γ and IL-4, apoptosis-related indicators such as PD-1 and IL-7, and endothelial injury related factors such as sTM, SDC-1 and HS were significantly improved compared with the pre-treatment, the improvement degree of the above indicators was more obvious than that of the standard treatment group, and LYM was significantly higher than that of the standard treatment group (×109/L: 1.3±0.3 vs. 0.9±0.4, P < 0.05), IL-4, IFN-γ, IFN-γ/IL-4 ratio, IL-7, PD-1, sTM, SDC-1, HS, and Ang-2 were significantly lower than those of the standard treatment group [IL-4 (ng/L): 2.8 (1.5, 3.2) vs. 3.3 (2.7, 5.2), IFN-γ (ng/L): 6.3 (5.4, 106.5) vs. 217.9 (71.4, 517.1), IFN-γ/IL-4 ratio: 3.7 (1.8, 70.3) vs. 59.1 (18.3, 124.9), IL-7 (ng/L): 4.6 (3.2, 5.1) vs. 6.3 (5.2, 8.0), PD-1 (μg/L): 0.04 (0.03, 0.06) vs. 0.08 (0.05, 0.12), sTM (μg/L): 4.9 (4.3, 7.4) vs. 8.7 (6.0, 10.8), SDC-1 (μg/L): 0.6 (0.3, 1.1) vs. 0.9 (0.8, 2.5), HS (ng/L): 434.8 (256.2, 805.0) vs. 887.9 (620.1, 957.3), Ang-2 (ng/L): 934.0 (673.3, 1 502.1) vs. 2 233.9 (1 472.5, 3 808.4)], the differences were statistically significant (all P < 0.05). CBP treatment can eliminate the patient's immunosuppressive state, reduce a variety of endothelial injury markers and the degradation of glycocalyx, but cannot decrease the 28-day death risk or shorten the length of ICU stay.

Nursing Risk and Preventive Measures of Continuous Blood Purification Treatment

Nursing Risk and Preventive Measures of Continuous Blood Purification Treatment

Effects of Continuous Blood Purification without Heparin on Strem-1, NSE, and IL-10 Levels In Patients With Sepsis.

One of the most common causes of mortality and disability across the world is sepsis, a condition marked by an abnormal immunological reaction in the body. The prognosis of patients with sepsisis much improved when they are diagnosed early and provided with proper therapy. Soluble triggering receptors expressed on myeloid cells (STREM-1), Interleukin-10 (IL-10), neuronal serum enolase (NSE), and so on are possible biomarkers for the diagnosis of sepsis based on the pathophysiology. Blood purification treatment to control the cytokine storm induced by sepsis was regarded to be promising. Recently, the treatment of sepsis is likely to shift toward a multimodal approach. Hence in this paper, we investigated the effect of a continuous blood purification technique (hemofiltration without heparin followed by hemoadsorption) on STREM-1, NSE, and IL-10 levels in patients suffering from sepsis. A sample of hundred patients suffering from sepsis was randomly allocated to one of the two groups (study and control groups). The control group got standard sepsis care, whereas the research group got continuous blood purification treatment. To compare the differences between the two groups, we used t-statistical analysis. Blood STREM-1, IL-10, and NSE concentrations of the study group were significantly lesser than that of the control group after therapy. As a result, continuous blood purification can significantly minimize the dysregulated immune response in patients with sepsis, promote immune function and improve the survival rate.

Early continuous blood purification affects TNF-α, IL-1β, and IL-6 in patients with severe acute pancreatitis via inhibiting TLR4 signaling pathway.

To exploit whether early continuous blood purification (CBP) inhibits the Toll-like receptors 4 (TLR4) signaling pathway in the peripheral blood of patients with severe acute pancreatitis (SAP) and whether it affects the abundance of inflammatory factors; 130 SAP patients were randomly selected and divided into Groups B and C. Both groups received conventional treatment. Among them, Group C was given early CBP treatment. Another 60 healthy cases in physical examination at the same time were selected as Group A. The abundances of TLR4 and inflammatory factors were detected before and after treatment. Compared with Group B, (1) the symptoms in Group C improved more markedly; (2) protein contents of TLR4 and nuclear factor kappa B (NF-κB) in Group C diminished more signally; (3) the abundances of tumor necrosis factor alpha (TNF-α), cytokine interleukin-1β (IL-1β), and cytokine interleukin 6 (IL-6) in Group C decreased (p < 0.05); and (4) the abundance of TLR4 in Group C was positively correlated with those of TNF-α, IL-1β, and IL-6 after treatment (all p < 0.001). Early CBP inhibits TLR4 signaling pathway in SAP patients and attenuates the abundance of inflammatory factors to a certain extent, which may provide a new clinical treatment strategy for SAP.

CT Image Feature under Intelligent Algorithm in the Evaluation of Continuous Blood Purification in the Treatment and Nursing of Pulmonary Infection-Caused Severe Sepsis.

This study was to explore the CT image features based on intelligent algorithm to evaluate continuous blood purification in the treatment of severe sepsis caused by pulmonary infection and nursing. 50 patients in the hospital were selected as the research objects. Convolutional neural network algorithm was used to segment CT images of severe sepsis caused by pulmonary infection. They were randomly divided into 25 cases of experimental group and 25 cases of control group. The experimental group was given continuous blood purification treatment, combined with comprehensive nursing. The control group was given routine treatment and basic nursing. Fasting plasma glucose (FPG) and fasting insulin (FIN), interleukin-6 (IL-6), tumor necrosis factor (TNF-α), high-sensitivity c-reactive protein (hs-CRP) levels, CD3+, CD4+, CD4+/CD8+ levels, ICU monitoring time, malnutrition inflammation score (MIS), and incidence of adverse events were compared between the two groups before and after treatment. There was no difference in FPG and FIN between the two groups before treatment. After treatment, the FPG and FIN of the experimental group were lower than those of the control group, and there was statistical significance (P < 0.05). There was no difference in IL-6, TNF-α, and hs-CRP between the two groups before treatment. After treatment, IL-6, TNF-α, and hs-CRP in the experimental group were lower than those in the control group. There was no difference in the percentage of CD3+, CD4+, and CD4+/CD8+ between the two groups before treatment. After treatment, the CD3+, CD4+, and CD4+/CD8+ in the experimental group were higher than those in the control group. The ICU monitoring time, MIS, and incidence of adverse events in the experimental group were lower than those in the control group (P > 0.05). Convolutional neural network algorithm can accurately identify and segment CT images of patients with severe sepsis, which has high clinical application value. Continuous blood purification therapy can effectively control blood glucose level, improve immune function, and reduce the content of inflammatory factors in patients with severe sepsis caused by pulmonary infection. Effective nursing measures can improve the therapeutic effect.

The effects of blood purification combined with antibiotics on extravascular lung water index, inflammatory factors, and prognosis of patients with severe acute pancreatitis complicated with acute respiratory distress syndrome.

To retrospectively analyze the effects of routine treatment and blood purification combined with antibiotics on the extravascular lung water index (EVLWI), inflammatory factors, and treatment outcomes in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). A total of 131 SAP patients admitted to the intensive care unit of Suzhou Ninth Hospital Affiliated to Soochow University from January 2019 to December 2020 were retrospectively enrolled in this study. Patients were divided into two groups according to the treatment methods. In addition to conventional treatment, 60 patients in group A received continuous blood purification (CBP) treatment and 71 patients in group B did not. The EVLWI, inflammatory factors, remission time of clinical symptoms, curative effect, and patient outcomes were recorded at admission and after 1, 3, 5, and 7 days of treatment. There was a statistically significant difference in the clinical symptom relief time and the clinical efficacy between the two groups of patients (P<0.05). The mortality rate of patients in group A was 3.33%, which was significantly lower than the 14% mortality rate observed in patients in group B (P<0.05). The EVLWI, as well as the C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α levels were significantly lower in group A patients compared to group B patients on day 1, 3, and 7 post-treatment (P<0.05). There was also a significant difference in APACHE II scores between the two groups (P<0.05). The incidence of adverse reactions in group A was 6.7%, which was significantly lower than the 22.5% incidence observed in group B (P<0.05). Continuous blood purification combined with antibacterial drugs is safe and has a significant effect on the treatment of SAP patient complicated with ARDS, including effectively relieving clinical symptoms and signs, reducing the level of inflammatory factors, and promoting early disease outcomes.

WITHDRAWN: Support vector machine in image recognition of nursing methods for critically ill blood purification

Abstract Critically ill blood purification is an effective treatment, but the wrong way of nursing in the later stage will also lead to the threat to the life safety of patients. In order to explore effective nursing methods for critically ill blood purification, the study divided the patients into two groups, the control group and the experimental group, and the two groups each included 50 patients. The control group was routinely treated, and the experimental group was given continuous blood purification treatment and treated accordingly. After the nursing, the mortality of the two groups was observed and compared. After that, combined with support vector image analysis, the blood purification effects of different groups of patients were analyzed. The research shows that the support vector machine has a good feature recognition effect, which can be applied to the comparison of different nursing methods and can provide theoretical reference for subsequent related research.

Effect of early continuous blood purification on the prognosis of children with septic shock: a prospective randomized controlled clinical trial

To study the effect of early continuous blood purification (CBP) on the prognosis of children with septic shock. A prospective analysis was performed for the children with septic shock who did not reach the 6-hour initial recovery target and/or had a fluid overload of >10%. According to the treatment time of CBP, they were divided into an early group with 30 children and a conventional group with 28 children. The two groups were compared in terms of the start time of CBP and 28-day mortality rate, as well as the related indexes in the children who were cured. The early group had a significantly earlier start time of CBP than the conventional group (P<0.05). There were 25 children cured in the early group and 22 cured in the conventional group, and there was no significant difference in 28-day mortality rate between the two groups (P>0.05). The children who were cured in the early group had significantly shorter correction time of lactic acid, urine volume, and fluid overload than those in the conventional group (P<0.05). The children who were cured in both groups had significant reductions in the percentages of T-lymphocyte subsets at the beginning (P<0.05); on reexamination on day 7, the percentages of T-lymphocyte subsets were increased and were higher in the early group than in the conventional group (P<0.05). The children who were cured in the early group had significantly shorter duration of CBP treatment, duration of mechanical ventilation, and length of stay in the PICU than those in the conventional group (P<0.05). For children with septic shock who do not reach the 6-hour initial recovery target and/or have a fluid overload of >10%, early CBP treatment can quickly control the disease, shorten the course of disease, and accelerate immune reconstruction.

Clinical study on early application of continuous blood purification in the treatment of severe craniocerebral injury

Objective To study the clinical significance of early usage of continuous blood purification on the treatment of severe craniocerebral injury. Methods 85 Patients with severe brain injury admitted in our department were randomly divided into continuous blood purification treatment group (experiment group, 42 patients) and conventional treatment group (control group, 43 patients). patients in continuous blood purification treatment group were treated by continuous blood purification and traditional treatment from 1-7 days, traditional treatment group only were treated by the traditional treatment methods. To detect tumor necrosis factor (TNF)-α, neuron specific enolase (NSE) and pNF-H in 1 and 5 day. On the 28th day Apache Ⅱ score, ICU stay time and GCS score of two groups. To detect 6 months survival rate of two groups. Spss15.0 software was used for statistical analysis, The measurement data are subject to T test The survival rate and quality of life comparison between the two groups was compared by χ2 test, P<0.05 was considered statistically significant. Results Incidence of 5 days of TNF-α (4.85±0.45) ng/L (t=6.890, P 0.05). Conclusion Early continuous blood purification treatment improves the survival rate and quality of life of patients with severe brain injury which have higher clinical value. Key words: Continuous blood purification; Sever brain injury; Early treatment

Research progress on the causes and preventive measures of central venous catheter blockage

Central venous catheters (CVCs) are now widely used in critical care for critical care, fluid resuscitation, drug infusion, parenteral nutrition, hemodynamic monitoring, chemotherapy, and continuous blood purification treatment. Although the application of CVCs can facilitate clinical medical care work, the proportion of patients with various catheter complications will exceed 15%, and the incidence of catheter blockage is about 25%. At present, adequate flushing and effective sealing are considered to be important means to reduce and prevent catheter blockage. This article reviews the prevention of central venous catheter occlusion with different sealing fluids, in order to provide reference for clinical nurses to prevent central venous catheter occlusion. Key words: Central venous catheter; Normal saline; Heparin saline; Blocking

Differential clinical benefits of continuous blood purification treatment in critically ill patients with variable APACHE II scores.

The present study aimed to assess whether the Acute Physiology And Chronic Health Evaluation (APACHE) II score may be used to predict whether critically ill patients benefit from continuous blood purification (CBP) treatment. A total of 115 critically ill patients were retrospectively reviewed and grouped according to their baseline APACHE II scores. Each group was further divided into 2 groups based on whether they received CBP or not. At 72 h after CBP treatment, clinical indicators comprising the plasma levels of inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8, as well as endotoxin and procalcitonin (PCT), and severity scores (APACHE II, multiple organ dysfunction syndrome and systemic inflammatory response syndrome), were analyzed in all patients. It was observed that while CBP slightly reduced the severity scores in all patients, it significantly improved those in patients with an APACHE II score of 20-29 (P<0.05). Similarly, the plasma levels of TNF-α, IL-6, IL-8, endotoxin and PCT were significantly lower in patients receiving CBP than in those without CBP when the APACHE II score was 20-29 (P<0.05). Furthermore, CBP treatment significantly decreased the fatality rate and length of stay at the intensive care unit (ICU) for critically ill patients with an APACHE II score of 20-29 (P<0.05). In conclusion, CBP significantly decreases the inflammatory response, shortens the length of stay at the ICU and improves the prognosis for critically ill patients with an APACHE II score of 20-29 points. This observation suggests that the APACHE II score is an important clinical indicator to determine the potential benefit of CBP therapy in critically ill patients.

Noninvasive cardiac output monitoring using bioreactance in pediatric continuous blood purification patients

Objective To study the influence of continuous blood purification(CBP) on cardiac output of pediatric patients using bioreactance. Methods Patients underwent CBP in PICU and nephrology ward from March 2014 were prospectively enrolled after approval by ethics committee.CBP therapies were all performed by Fresenius Medical Care hemodialysis machine.Cardiac output values were obtained using the non-invasive cardiac output monitoring(NICOM) device (Cheetah Medical). Blood pressure, heart rate, cardiac index(CI) and stroke volume index(SVI) were recorded before the therapy, at the beginning of therapy, during the course of therapy, and at the end of each therapy. Results Twenty-one pediatric patients (from 1.0 year to 15.5 years) were recruited and 69 treatments were recorded from March 2014 to December 2016.The basic CI was 3.4 (2.4, 6.1) L/(min·m2), basic SVI was 43 (26, 75) ml/(m2·beat). During the beginning of therapy, mean arterial pressure(MAP), CI and SVI all dropped from the baseline (P<0.001), whereas heart rate increased.During the course of CBP, CI and SVI (were both recorded every 4 hours) kept on dropping and stayed at a relatively lower level.Course CI was 3.0 (2.4, 4.6) L/(min·m2) and course SVI was 28 (21, 57) ml/(m2·beat). At the end of therapy, CI was 3.4 (2.5, 5.3) L/(min·m2), with no significant difference from the baseline CI (P=0.073). However, the SVI at the end of therapy was 35 (25, 67) ml/(m2·beat), higher than the course SVI but still lower than the basic SVI, the differences were statistically significant (P<0.05). Conclusion CI and SVI continue to decline at the beginning of CBP treatment and remain at a lower level throughout the course of treatment.After the therapy, CI has returned to the basic level whereas SVI has not recovered. Key words: Bioreactance; Noninvasive cardiac output monitoring; Continuous blood purification; Children,

Application value of continuous blood purification in pediatric intensive care unit: analysis of 203 cases

To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed. (1) A total of 203 children were included, male accounted for 59.1%; age 37 days to 14 years old, with an average of (4.52±3.60) years old; weight 3.3-68.0 kg, with an average of (21.38±13.77) kg. (2) There were a total of 660 CBP treatments, with an average of 3.25 times per person. The main treatment modes of CBP were plasma exchange (PE, 38.64%), and followed by continuous veno-venous hemodiafiltration (CVVHDF, 38.64%), hemoperfusion (HP, 16.51%) and continuous veno-venous hemofiltration (CVVH, 6.21%). (3) Central venous catheterization was mainly placed in the right internal jugular vein (90.64%), followed by the right femoral vein (5.42%) and the left femoral vein (3.94%). (4) Heparin sodium was the main anticoagulant in pipeline filters (84.73%), followed by low molecular weight heparin calcium (11.33%), sodium citrate and non-anticoagulant (both 1.97%). Mixed anticoagulants were used 21 children. (5) Primary diseases included poisoning (26.11%), liver failure (25.62%), sepsis (12.32%), shock after cardiopulmonary resuscitation (11.82%), acute respiratory distress syndrome (ARDS, 8.37%), central nervous system diseases (5.41%) and metabolic diseases (4.93%). The lowest efficacy of CBP was metabolic diseases, with mortality rate of 60.00%; followed by ARDS, shock after cardiopulmonary resuscitation, sepsis and liver failure, with mortality was 58.82%, 41.67%, 36.00% and 32.69%, respectively. The length of hospitalization stay of children with central nervous system diseases was (30.89±15.13) days. (6) Adverse events of CBP treatment included uncontrollable restlessness (2.88%), hypotension (1.82%), allergic rash (1.21%), catheterization and pipeline coagulation (1.21%), filter coagulation (1.06%), decreased heart rate and oxygen saturation (0.76%); CBP was stopped in 8 children due to cardiac arrest during the treatment. At present, the application of CBP technology in pediatric ICU is universal, and it is an important way to rescue critical illness.

Safety and efficacy of heparin free anticoagulant continuous blood purification in treatment of sepsis patients in intensive care unit

Objective To investigate the safety and efficacy of heparin free anticoagulant continuous blood purification (CBP) in the treatment of intensive care unit (ICU) sepsis. Methods From October 2015 to October 2017, a total of 80 patients with sepsis treated in ICU with CBP in No.307 Hospital of PLA were included in this study using the random number table. Patients were divided into study group (n=40) and control group (n=40) according to the anticoagulant methods, of which the study group received heparin free anticoagulation, while the control group was given low molecular-weight heparin anticoagulation. The clinical outcome, renal function index and coagulation function were analyzed retrospectively. Paired t test was used to compare acute physiology and chronic health evaluation (APACHE) Ⅲ scores predicted mortality, urea nitrogen level, serum creatinine level, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) between two groups before and after treatment. χ2 test was used in analyzing survival rates in 28 d between two groups after treatment. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from all participants. Results ① Before treatment, APACHE Ⅲ scores predicted mortality was (89.6±14.8)% in study group, and was (90.1±13.8)%in control group, and there was no significant difference between two groups (P>0.05). After treatment, 28 d survival rate was 40.0% in study group, and was 47.5% in control group, and there was no significant difference between two groups (P>0.05). ② After treatment, urea nitrogen level was (12.8±1.7) mmol/L, blood creatinine level was (162.5±21.7) μmol/L in study group, and all were significantly lower than those before treatment, which were (22.7±3.8) mmol/L and (276.4±35.8) μmol/L, and the differences were statistically significant (t=8.827, 9.102; P=0.002, 0.000). After treatment, urea nitrogen level was (10.7±2.9) mmol/L, and serum creatinine level was (142.4±37.0) μmol/L in the control group, and all were lower than those before treatment, which were (26.1±3.1) mmol/L, (322.3±38.9)μmol/L respectively, and the differences were statistically significant (t=8.182, 8.992; P=0.006, 0.000). And levels of urea nitrogen and blood creatinine in the 2 groups after treatment were not statistically different (P>0.05). ③ After treatment, platelet count was (67.9±18.7) ×109/L, PT was (19.6±6.7) s, APTT was (28.7±6.1) s and TT was (3.0±1.1) s in study group, and all were significantly lower than those before treatment, which were (117.5±26.8) ×109/L, (28.6±7.9) s, (61.9±15.7) s and (24.2±6.9) s respectively, and the differences were statistically significant (t=7.233, 7.527, 6.232, 7.426; P=0.012, 0.011, 0.037, 0.007). Platelets count was (72.7±16.9) ×109/L, PT was (18.6±6.8) s, APTT was (31.9±7.1) s, and TT was (3.0±1.1) s in the control group, and all were significantly lower than these before the treatment, which were (109.7±25.7) ×109/L, (25.8±6.9) s, (56.7±14.9) s, (24.3±6.9) s respectively, and the differences were statistically significant (t=9.125, 6.728, 6.426, 7.529; P=0.000, 0.029, 0.031, 0.006). Platelet count, PT, APTT and TT levels in the 2 groups after treatment were not statistically different (P>0.05). Conclusions Heparin free and low molecular-weight heparin CBP therapy both can improve the clinical symptoms and renal function index of patients with sepsis in ICU. Heparin free anticoagulation CBP could not lead to abnormal coagulation function and increase platelet consumption, and could improve safety. Key words: Anticoagulant; Heparin, low-molecular-weight; Sepsis; Heparin free anticoagulant; Continuous blood purification

Effect of continuous blood purification on peripheral blood monocyte membrane binding CD14 expression and inflammatory response in patients with traumatic sepsis

Objective To investigate the effect of continuous blood purification (CBP) on peripheral blood monocyte membrane CD14 (mCD14) expression and inflammatory response in patients with traumatic sepsis Methods A retrospective case control study was conducted on the clinical data of 50 patients with severe sepsis after trauma treated between January 2015 and December 2016. There were 34 males and 16 females, with an average age of 45.37 years (range, 16-73 years). Patients were divided into CBP group (25 cases) and non-CBP group (25 cases) according to whether they agreed to receive CBP treatment. The peripheral blood samples were collected at 0, 12, 24, 48, and 72 hours after treatment, and the mCD14 and leukocyte elastase (HLE) expressions were detected by flow cytometry and by ELISA, respectively. The peripheral blood mononuclear cells were isolated from the two groups 24 h after treatment and cultured in vitro. The variations of mCD14 expression in mononuclear cells were measured at 4, 8, 12, 24, 48, and 72 h after stimulation with lipopolysaccharide (LPS). The expression levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in mononuclear cells were detected by ELISA. Results At 12, 24, 48, and 72 hours after treatment, the leukocyte elastase levels in the two groups were lower than those before treatment (P 0.05). Conclusions CBP treatment can increase monocyte mCD14 expressions through eliminating inflammatory factors and pro-inflammatory mediators and reducing HLE directly or indirectly in patients with traumatic sepsis. When the body is stimulated again, its anti-inflammatory response ability is markedly stronger than that of patients who have not received CBP treatment. Key words: Sepsis; Wounds and injuries; Hemofiltration; Membrane CD14

Abstract P-118: THE APPLICATION OF CONTINUOUS BLOOD PURIFICATION IN PEDIATRIC INTENSIVE CARE: AN ELEVEN-YEARS EXPERIENCE

Aims & Objectives: To report the efficacy and outcomes of Continuous Blood Purification (CBP) in our PICU over the past eleven years Methods Clinical data of the children treated with CBP in the PICU of Children’s Hospital of Fudan University from Jan. 2004 to Dec. 2014 was retrospectively analyzed Results A total of 359 patients were admitted into our PICU and underwent blood purification treatment during this period. The primary diseases were sepsis, followed by renal failure, liver failure, toxication and autoimmune diseases such as Guillain-Barre syndrome in order. The median PRISM-III score in the first 24 hours after admission is 19 (0–58), and the median ICU days is 8 (1–95) days. In terms of prognosis, a total of 92 children died, the mortality rate was 25.6%. During the eleven years, Sepsis rose to the first place as primary disease, a Hybrid CBP mode by combination of CVVHDF with other blood purification modes was used more often. Several indicates were compared before and after the runs including creatinine Potassium PH and so on, which indicates that CBP treatment is effective Conclusions CBP is safe to use in PICU. In addition, non-renal diseases, especially sepsis has become the main area of its application in PICU

Clinical analysis of 48 patients with acute mushroom poisoning

To analyze the clinical manifestation and therapeutic method in patients with acute mushroom poisoning. A retrospective study was conducted. The clinical data of 48 patients with acute mushroom poisoning admitted to Department of Poisoning Treatment of the 307th Hospital of PLA from January 2016 to May 2017 were analyzed. The clinical data including gender, age, clinical symptoms, onset season, initial symptoms, incubation time, the length of hospital stay, treatment, and prognosis. In addition to the conventional treatment, the patients with severe liver damage were treated with continuous blood purification (CBP). The changes in routine blood test, biochemical parameters, blood ammonia and coagulation function before and 1, 3 and 7 days after CBP were observed. There were 29 of male (60.4%) and 19 of female (39.6%) in 48 patients with acute mushroom poisoning, with an average age of (48.10±13.14) years. There were 9 patients suffering from gastroenteritis type, 26 suffering from liver damage type, 8 suffering from neuro-psychosis type, 2 suffering from hemolytic type, and 3 suffering from renal damage type. All of the poisoned patients had evident seasonal characteristic, mainly concentrated in the autumn, especially in August, according for 66.7% (32/48). The initial symptoms of poisoning patients were mainly manifested as nausea and vomiting (50.0%). In five kinds of poisoned patients, the incubation time [(1.44±1.15) hours] and the length of hospital stay [(3.50±2.33) days] of neuro-psychosis type was the shortest, and the incubation time of liver-damaged type [(10.63±3.50) hours] and the length of hospital stay of renal damage type [(20.67±0.58) days] was the longest. Patients received symptomatic treatment according to different types, among whom 12 patients with severe liver damage received additional treatment for CBP. After the treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and prothrombin activity (PTA) were significantly improved as compared with those before CBP treatment, with significant differences between 7 days after CBP and before CBP [ALT (U/L): 213.08±127.30 vs. 2 766.83±1 909.66, AST (U/L): 50.00 (41.00, 85.00) vs. 2 142.00 (1 225.00, 3 126.00), CK-MB (U/L): 24.09±8.87 vs. 44.75±22.09, LDH (μmol×s-1×L-1): 3.70±1.46 vs. 13.03±12.77, PTA: (79.08±24.29)% vs. (35.25±19.85)%, all P < 0.01]. Among 48 patients, 47 were cured and discharged, and 1 patient with liver failure died due to aggravation of liver dysfunction, abnormal coagulation and bleeding, and massive hemorrhage of gastrointestinal tract. Acute mushroom poisoning patients demonstrated obvious seasonal characteristics, mostly liver-damaged type, and its initial symptoms were mainly presented as nausea, vomiting and other gastrointestinal manifestations. Early clarification of diagnosis, timely treatment, as well as providence with CBP treatment in severe patients should be carried out as soon as possible. In such a way the curative effect can be enhanced, the mortality can be reduced, and the prognosis of the patients could be improved.

Effects of application of citrate anticoagulation in bedside continuous blood purification of severe burn patients with sepsis

Objective: To investigate the effects of application of citrate anticoagulation in bedside continuous blood purification (CBP) of severe burn patients with sepsis, so as to provide reference for choosing anticoagulants in CBP of these patients. Methods: Thirty severe burn patients with sepsis, conforming to the study criteria, were admitted to our burn intensive care unit from January 2014 to July 2017. Patients were divided into heparin group and citrate group according to computer randomization method, with 15 cases in each group. Patients in two groups all received bedside CBP treatment. Patients in heparin group used local heparin anticoagulation, while patients in citrate group used local citrate anticoagulation. Time of predicted single-time CBP treatment, time of single-time CBP treatment, time of accumulative CBP treatment, and rate of reaching the standard of CBP treatment time were counted. Changes of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, serum procalcitonin, and C-reactive protein (CRP) of patients before and after treatment were monitored. Hemorrhage in wounds, incision on trachea, and arteriovenous intubation point, and other complications during and after CBP treatment were observed. Data were processed with independent sample t test and chi-square test. Results: (1) Time of predicted single-time CBP treatment of patients in the two groups was equal. Time of single-time CBP treatment and time of accumulative CBP treatment of patients in citrate group were longer than those in heparin group. Rate of reaching the standard of CBP treatment time of patients in citrate group was significantly higher than that in heparin group (χ(2)=16.655, P<0.01). (2) There was no statistically significant difference in PT, APTT, INR, fibrinogen, serum procalcitonin, and CRP of patients in the two groups before CBP treatment (t=0.203, -1.006, 0.203, 0.039, -1.591, -0.824, P>0.05). PT and APTT of patients in citrate group after CBP treatment were (14.2±1.6) and (45±7) s, respectively, significantly shorter than (15.5±1.4) and (53±6) s in heparin group (t=2.395, 3.321, P<0.05 or P<0.01). INR of patients in citrate group after CBP treatment was 1.13±0.12, significantly lower than 1.24±0.12 in heparin group (t=2.395, P<0.05). Fibrinogen of patients in citrate group after CBP treatment was (3.5±0.6) g/L, significantly higher than (3.0±0.6) g/L in heparin group (t=-2.427, P<0.05). Serum procalcitonin and CRP of patients in citrate group after CBP treatment were significantly lower than those in heparin group (t=2.520, 2.710, P<0.05). Decreased degree of serum procalcitonin and CRP of patients in citrate group after CBP treatment were (1.8±0.6) ng/mL and (143±69) mg/L, respectively, significantly higher than (0.9±0.6) ng/mL and (95±50) mg/L in heparin group (t=-4.033, -2.170, P<0.05 or P<0.01). (3) During CBP treatment, patients in heparin group experienced 21 times of exacerbation of wound hemorrhage and 10 times of new hemorrhage, including 2 times of hemorrhage at incision on trachea and 8 times of hemorrhage at arteriovenous intubation point. No exacerbation of hemorrhage or new hemorrhage happened in patients of citrate group. After CBP treatment, no electrolyte disturbance happened in patients of heparin group, but 1 patient in citrate group experienced hypocalcemia. Conclusions: Application of citrate anticoagulation in bedside CBP of severe burn patients with sepsis shows light impact on systematic coagulation status, and can effectively decrease inflammation reaction of burn sepsis with low rate of hemorrhage.

Continuous Blood Purification Ameliorates Multiple Organ Failure Through Inhibiting the Activation of the P38 MAPK Signaling Pathway in a Rat Model

Background/Aims: Multiple organ failure (MOF) is a primary threat to the survival of patients with systemic inflammation. Blood purification is employed in the treatment of MOF, as an artificial kidney or artificial liver. This study focuses on the effects of continuous blood purification (CBP) on ameliorating MOF through regulating the p38 mitogen-activated protein kinase (MAPK) signaling pathway in a rat model. Methods: A rat model of MOF was successfully established by endotoxin injection after hemorrhagic shock resuscitation. The mRNA expressions of inducible nitric oxide synthase (iNOS) and p38 MAPK of liver, kidney, and lung tissues in each group were measured by RT-qPCR at each measuring time point. To evaluate the activation of p38 MAPK signaling pathway, protein levels of phosphorylated p38 (p-p38) MAPK and p38 MAPK was measured by western blot analysis. The serum levels of nitric oxide and TNF-α were determined. Results: After CBP treatment, the levels of SGPT, SGOT, Cr, and BUN were significantly declined, while the PaO₂ value was increased. Expressions of p38 MAPK mRNA, iNOS mRNA, p-p38 MAPK protein and p38 MAPK protein, and nitric oxide and TNF-α levels were markedly elevated in MOF, an effect blunted by CPB. Meanwhile, pathological sections of liver, kidney, and lung tissues after CPB treatment ameliorated swelling and inflammation. Conclusion: Our study proved that CBP could downregulate the p38 MAPK signaling pathway, suppress iNOS expression, reduced the serum levels of nitric oxide and TNF-α, thus ameliorate symptom of MOF.