Efficacy Of Blood Purification Research Articles

Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis.

This study aimed to evaluate the therapeutic efficacy and effect of blood purification (BP) therapy on severe acute pancreatitis (SAP). Information on 305 patients (BP group 68, control group 237) diagnosed with SAP was retrieved from the Medical Information Mart for Intensive Care IV (MIMIC IV) database. Firstly, the influence of BP treatment was preliminarily evaluated by comparing the outcome indicators of the two groups. Secondly, multiple regression analysis was used to screen the mortality risk factors to verify the impact of BP on the survival outcome of patients. Then, the effect of BP treatment was re-validated with baseline data. Finally, cox regression was used to make the survival curve after matching to confirm whether BP could affect the death outcome. The results indicated that the BP group had a lower incidence of shock (p = 0.012), but a higher incidence of acute kidney injury (AKI) (p < 0.001), with no differences observed in other outcome indicators when compared to the control group. It was also found that the 28-day survival curve of patients between the two groups was significantly overlapped (p = 0.133), indicating that BP treatment had no significant effect on the survival outcome of patients with SAP. Although BP is beneficial in stabilizing hemodynamics, it has no effect on short- and long-term mortality of patients. The application of this technology in the treatment of SAP should be done with caution until appropriate BP treatment methods are developed, particularly for patients who are not able to adapt to renal replacement therapy.

トリカブト中毒に対し血液吸着（direct hemoperfusion: DHP）が有効であった1例(A case of aconite poisoning treated with direct hemoperfusion (DHP))

要旨トリカブト中毒は比較的稀な自然毒中毒であり，難治性不整脈を呈し重症化するリスクも高い。しかし特異的な治療はなく対症療法や呼吸循環管理が主とされ，血液浄化療法の効果も明らかではない。今回我々は，トリカブト中毒に対し血液吸着（direct hemoperfusion: DHP）が有効であったと思われる1例を経験したので報告する。症例は80歳の男性。自殺目的に自身で調合したトリカブト粉末を服用し，不整脈（心室頻拍）と意識障害を来して前医救急搬送され，専門的治療目的に当院転送となった。来院時は多源性の心室性期外収縮（premature ventricular contraction: PVC）が頻発し血行動態不安定であり，人工呼吸管理下にアミオダロン持続投与を開始しつつDHPを行った。その結果PVCは徐々に減少し，DHP終了時には洞調律に安定，血行動態も回復した。トリカブトの主成分であるアコニチン，メサコニチン，ヒパコニチンの血中濃度は来院時それぞれ3.95ng/mL，5.22ng/mL，1.42ng/mLであったが，DHP終了時には0.29ng/mL，0.86ng/mL，0.28ng/mLと著明に低下しており，DHPの効果と考えられた。第2病日に抜管し，以降安定して経過。精神科の介入を経て第13病日退院となった。トリカブト中毒に対するDHPにより臨床症状の改善と良好な転帰を得られ，積極的に施行を考慮すべきと思われる。

Application of blood purification in acute lymphoblastic leukemia pediatric patients with hypermethotrexemia accompanied with acute kidney injury

Objective To investigate the efficacy of blood purification for acute lymphoblastic leukemia pediatric patients with high-dose methotrexate(MTX)-induced hypermethotrexemia and acute kidney injury (AKI). Methods The clinical data of 50 acute lymphoblastic leukemia pediatric patients with hypermethotrexemia (the 45th hour MTX blood concentration >20 μmol/L) and AKI who were admitted to Beijing Children's Hospital Capital Medical University from May 2010 to August 2018 were collected. After the treatment of blood purification, the declining rate of MTX concentration, the incidence of drug-related side effects and the clinical transition were analyzed retrospectively. Results The median MTX blood concentration at the 45th hour after high-dose MTX chemotherapy was 31.5 μmol/L (20.0-80.3 μmol/L). After blood purification treatment, 48 patients (96%) survived, 1 patient (2%) died, and 1 patient (2%) gave up treatment. It costed 10.0 days (7.0-15.0 days) to decline the MTX concentration to the normal level by using blood purification. The median time of purification was 32.5 hours (2.0-168.0 hours), and the days of dialysis were 3.0 days (1.0-9.0 days). The AKI occurred in approximately 96% (48/50) of patients, which was the main side effect. The time of declining the high MTX concentration to the normal was positively correlated with the increase times of serum creatinine (r = 0.371, P = 0.009) and urea nitrogen (r = 0.486, P = 0.001), and the value of the alanine aminotransferase (r = 0.364, P = 0.010) and gamma glutamyl transpeptidase (r = 0.344, P = 0.010), and the days of dialysis (r = 0.532, P < 0.01), but there was no relationship with the 45th hour MTX blood concentration (r=0.110, P = 0.248). The reduction of MTX blood concentration from the 45th hour to the 69th hour after high-dose MTX chemotherapy was negatively correlated with the increase times of urea nitrogen (r = -0.336, P = 0.009) and serum creatinine (r = -0.260, P = 0.035). Conclusion When the MTX blood concentration of patients with hypermethotrexemia and AKI couldn't be declined to the normal level by using high-dose leucovorin, hydration and alkalization, and without the effective detoxification drug (carboxypeptidase G2), they should be offered blood purification, especially continuous renal replacement therapy as soon as possible, which can reduce the blood concentration of MTX quickly and decrease the incidence of side effects effectively. Key words: Leukemia, lymphoblastic, acute; Methotrexate; Blood purification

Clinical and nursing efficacy of blood purification combined with ulinastatin in treatment of patients with severe acute pancreatitis

Clinical and nursing efficacy of blood purification combined with ulinastatin in treatment of patients with severe acute pancreatitis

Clinical efficacy of blood purification to treat children with acute amanita poisoning

目的 探讨致命毒蕈白毒伞中毒患儿早期血液净化救治的临床效果.方法 对2例急性白毒伞中毒致急性中毒性肝损害的患儿进行内科综合治疗、血浆置换、血浆置换联合血液滤过的相关治疗.监测肝功能、血氨、凝血四项等指标的恢复情况.结果 2例患儿经早期4次全量的血浆置换、血液滤过,可基本清除体内的白毒伞毒素,患儿的肝功能逐渐好转恢复.结论 在综合治疗的基础上,相对轻症病例单用血浆置换,重症病例血浆置换联合血液滤过可降低转氨酶、血氨,取得满意疗效,提高救治成功率。

Efficacy of blood purification on acute trichloropropane poisoning

三氯丙烷和二氯丙烷是油漆调和剂或清洗剂等溶剂的主要成分,通过呼吸道或误服经消化道进入体内后,对肝脏、神经系统等器官产生一系列严重损害.我院自2008年4至10月收治7例急性三氯丙烷中毒患者,经过血液净化等治疗后取得了较好的效果,现报告如下。