ABSTRACT
Objective To investigate the effect of coupled plasma filtration adsorption (CPFA) on plasma cytokines:TNF-α,IL-1β,IL-6,cellular immunity,blood lactate acid concentration,heart rate,respiration rate,oxygenation index,hemodynamics,blood cells counts,and prognosis in patients with multiple organ dysfunction syndromes (MODS).Methods This was a prospective,randomized clinical trial in 45 patients diagnosed as MODS.Patients were randomly assigned to hemoperfution with resin adsorption (HP) + continuous venous-venous hemofiltration (CVVH) group,CPFA group and CVVH group.The general clinical data,APACHE Ⅱ score,number of failure organ and previous mentioned biomarkers were documented.Blood samples were collected before and after blood filtration with any one of these procedures.The plasma samples were isolated and stored with frozen at-60 ℃.Data were statistically analyzed with SPSS 13.0 version software.Results In CPFA group,plasma cytokines,TNF-α、IL-1β、IL-6,decreased markedly after plasma adsorption for two hours (P ＜ 0.01);and plasma concentrations of IL-6 were further descended after subsequent CVVH for 10 hours (P ＜ 0.05).In HP + CVVH group,plasma cytokines,TNF-α、IL-1β、IL-6,decreased markedly after HP (P ＜ 0.01),and plasma concentrations of IL-6 were further descended after subsequent CVVH for 10 hours (P ＜ 0.05).In CVVH group,plasma cytokines,TNF-α、IL-1β、IL-6,decreased after CVVH for 12 hours (P ＜ O.05).Blood lactate acid concentration,heart rate,respiration rate,oxygenation index,T-lymphocytes subgroups (CD3 +,CD4 +,CD8 +,CD4 +/CD8 + ratio),clinical symptoms were improved and dose of vasoactive agent was reduced in the patients of three groups without differences among them.The counts of red blood cells,white blood cells and platelets after CPFA and CVVH showed no significant changes.There was no significant difference in blood cell counts between CPFA and CVVH groups.After HP + CVVH,there was a trend of decrease in platelet count (P ＜ 0.05).Platelet counts were significanfly higher in patients treated with CPFA and CVVH group than those in patients treated with HP + CVVH group (P ＜ 0.05).There were 6 patients died in HP + CVVH group,6 patients died in CPFA group and 5 patients died in CVVH group within 28days.Conclusions The comparison of efficacy of blood filtration among 3 modalities of HP + CVVH,CPFA and CVVH showed CPFA had higher capacity of Inflammatory medium scavenging than CVVH,and had less damage effect on blood visible component,especially on platelet compared with HP + CVVH.CPFA was an effective and safety modality in the treatment of the patients with multiple organ dysfunction syndrome.
ABSTRACT
Objective To observe the clinical efficacy of coupled plasma filtration adsorption (CPFA) combined with high volume hemofiltration (HVHF) for severe acute pancreatitis (SAP) and explore the practicality, the safety and the therapeutic mechanism. Methods This was a prospective, randomized clinical trail. A total of 29 patients with SAP were di-vided into two groups:treatment group (n=15, CPFA and HVHF) and control group (n=14, HVHF). The APACHEⅡscore, se-rum triglyceride, liver and kidney function, white blood cell (WBC), heart rate (HR), respiration, mean arterial pressure (MAP) and oxygenation index were compared before and after treatment between two groups. The organ function was as-sessed, and the adverse reactions and prognosis were observed in two groups. Results After treatment, there were signifi-cant decreases in APACHEⅡscore and WBC, and significant increase in PaO2/FiO2 in two groups, especially significant in treatment group. There was a significant decrease in the level of triglycerides in 7-d treatment group than that of 3-d treat-ment group (P＜0.05). There were no thrombocytopenia, bleeding, allergies, blood clotting and other adverse reactions in two groups of patients. There were significant decreases in the blood purification time and the length of hospital stay in treatment group than those of control group (P＜0.05). There was no significant difference in mortality between two groups. Conclu-sion CPFA combined with HVHF can effectively control inflammation, reduce the serum level of triglyceride and improve the prognosis in patients with SAP.