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Objective To investigate the effect of blood hemoperfusion with resin adsorption connected in series to continuous veno-venous hemofiltration ( HP + CVVH) on plasma cytokines such as TNF-α,IL-1β,IL-6 as well as cellular immunity and prognosis of patients with multiple organ dysfunction syndromes (MODS). Methods It was a prospective,randomized clinical trial.A total of 30 patients diagnosed as MODS were randomly (random number) divided into routine treatment + HP + CVVH group (treatment group) and routine treatment + CVVH group (control group).In treatment group,patients received blood hemoperfusion with resin adsorption for 2 hours,and then CVVH for 10 hours every day for 3days.In control group,patients received CVVH for 12 hours every day for 3 days.The plasma samples of patients in treatment group were obtained 0 h,2 h,12 h,24 h,26 h,36 h,48 h,50 h,60 h,5 days,7 days and 10 days after renal replacement therapy.The plasma samples of patients in control group were obtained 0 h,12 h,24 h,36 h,48 h,60 h,5 days,7 days and 10 days after renal replacement therapy.All of these patients were monitored with APACHE Ⅱ score,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,respiration rate and oxygenation index. Results Plasma levels of TNF-α,IL-1β and IL-6 decreased dramatically after HP (P ＜ 0.01 ) and T-lymphocytes subpopulations CD3+,CD4 +,CD8 + and CD4 +/CD8 + increased after both HP + CVVH and CVVH.The differences in plasma levels of TNF-α,IL-1βand IL-6 of patients between two groups were not noticeably obvious at the intervals of 12 h,36 h,and 50 h after renal replacement therapy. But on the 5 th day after renal replacement therapy,plasma levels of TNF-α,IL-1βand IL-6 of patients in HP + CVVH group were lower than those in control group (P ＜ 0. 05 ).There were 5 fatal patients in HP + CVVH group and 6 patients died off in CVVH group during 28 days after treatment.Conclusions Both HP + CVVH and CVVH could lower the levels of plasma TNF-α,IL-1β and IL-6,and improve cellular immunity and clinical symptoms as well as signs.Compared with CVVH,plasma levels of TNF-α,IL- 1β and IL-6 were lower on the 5th day and increase rate of 28-day survival in HP + CVVH group.
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OBJECTIVE To observe the type of nosocomial infections in our comprehensive ICU,the prevalence and the vicissitude characteristic of infection strains,and the change of antibiotic-resistance.METHODS To summarize the 10 year results of the monitoring which were divided into three stages to compare the changes with time.RESULTS Gram-negative bacilli were 987(76.4%),Gram-positive cocci 216(16.7%) strains,and 89 strains were fungi(6.9%).The top six strains were in turn:Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae,Escherichia coli,and Stenotrophomonas maltophilia.Distribution of infection sites: 92.3% infection was in lungs,5.2% in urinary tract infection,2.5% in other sites included lungs,abdomene,CSF,blood etc.CONCLUSIONS The main nosocomial infective pathogens in our ICU are Gram-negative bacilli(75.0%),Gram-positive bacterial infection shows a slight increasing,whereas fungi infection decreasing.In addition to S.maltophilia,the great majority of Gram-negative bacilli,ESBL-producing K.pneumoniae and E.coli maintain a higher sensitivity to carbapenem antibiotic.All Gram-positive cocci to vancomycin and teicoplanin maintain a good sensitivity.In the fungal infection,Candida albicans infection ratio is decreased,while non-C.albicans increases.