| Background:Sepsis is the common complication while Trauma,burn,shock and major operation. Septic shock is the considerable consequence in the process of sepsis, and is hypotension with severe sepsis ,and become a primary death cause of clinical severe case. The previous research results that the major mechanisms of septic shock are the excessive releases of various inflammation mediators (cytokine) and the activation of endotheliocyte, neutrophil and macrophagocyte, the interactions of these inflammation mediators result in systemic inflammatory response syndrome (SIRS),then damage of tissues and multiple organ dysfunction syndrome (MODS). Therefore, the reduction of these cytokine is a potential therapeutic measure. However,It has been shown that therapy aimed for inflammatory factor, such as monoclonal antibody, remains unsuccessful. Recently, research has focused on blood purification against the sepsis and sepsis shock. As the outcome of variant methods of blood purification were differential, more effective ways are necessary. For the unique rationales of every approach,it was reported the combination of different intervention would be the certain trend in the treatment of SIRS and MODS. The combination of hemoperfusion(HP) and continuous veno-venous hemofiltration(CVVH) contains multiple mechanisms of blood purification, including the strengthened adsorption rationale, may has special advantages on the therapy of septic shock, but the cinical studis were scarce.Objective:we investigate the effects and the mechanisms of variant methods, including HP,CVVH or their combination, for the therapy of septic shock through serum cytokine levels, which would be new evidences for the better intervention for septic shock.Metheds:A total of 36 septic shock patients were recruited from Intensive care unit at the Southwest Hospital between September 2009 and October 2010. These subjects were classified into three groups randomly(table of random muber)according the different therapy. The control group(group C) was routinely treated by antibiotics, lesion clearance,and Supporting Therapy. The CVVH group (Group V) was treated by CVVH for 24h on the first day and the third day on the basis of routine therapy. The HP+CVVH(Group H)was treated by HP for 2h, followed by CVVH for 22h on the first day and the third day on the basis of routine therapy. The survival rate,the vital sign, Hemodynamic parameter,oxygenation index,and organ functions were evaluated and the serum TNF-α,IL-6,IL-10 HMGB-1 were measured on different phase.Results:1. The 28d survival rate:The 28d survival rate of the Group C, Group V and the Group H were 41.67%, 58.33%, 66.67%, but Differences among the groups were not statistically significant.2. The SOFA Score:The SOFA Score in Group V were lower than in group C from the fourth day on(P<0.05). It was also lower in group H than group C from the second day on(P <0.05)。3. The serum cytokine:There were no significant differences in TNF-α, IL-6, HMGB-1, IL-10 between group C and group V in the first day and the third day(P>0.05), but the TNF-α, HMGB-1, IL-10 in group H were decreased after 2h HP treatment(P <0.05).4. The oxygenation index and the time of breathing machine use:The oxygenation index was increased from the 4th day in group V compared with group C (P<0.05) . The oxygenation index in group H was higher than group C from the second day (P <0.05),and was higher than group V in the second and third day(P<0.05). The time of breathing machine use was reduced in group H and group V as compared with group C(P <0.05), but no differences were seen between the two groups(P >0.05). 5. Hemodynamic parameter:The time of vasoactive agent use was shorten in group H and group V as compared with group C(P <0.05), but no differences were seen between the two groups. The heart rate was decreased in 3d, 4d and 7d in group V as compared with group C(P<0.05);The heart rate was decreased from the second day to the 7th day in group H as compared with group C(2d, 5d, 6d, 7d, P<0.05; 3d,4d, P<0.01).There were no significant differences in heart rate between group V and group H(P﹥0.05).6. Body temperature: As compared with group C, the body temperature was decreased in group V from the second day to the 6th day(P<0.05) and in group H from the second day to the 7th day (2 ~6d, P<0.01;7d, P<0.05). There were no significant differences in body temperature between group V and group H(P﹥0.05).7. PH value:As compared with group C, the PH value in group V was increased in the 4th and 5th day(P<0.05) and was increased in group H in second and 5th day(P<0.05). There were no significant differences in PH value between group V and group H(P﹥0.05).8. Hematological system:As compared with group C, the WBC was lower in group V and group H(P<0.05), and the Fib, PT, Hb, PLT were not statistically significant(P﹥0.05). The APTT in group V was prolonged in the third and 4th day with regard to the group C(P<0.05).9. Electrolytes:As compared with group C, the serum calcium in group V and group H were higher(P<0.05) and serum natrium and serum kalium in group H were higher(P<0.05). 10. Other biochemical indicators:As compared with group C, the blood glucose, lactic acid, Cr, UN, AST, GGT, ALP were all decreased in group V and group H(P<0.05), while there were no significant differences between the two groups. The LDH,α-HBDH, ALT, DB were lower in group H than group C,but no significant differences were seen between group V and group C.Conclusion:1. Blood purification conduce to the elevation of the 28d survival rate in septic shock patients. The 28d survival rates in the Group C, Group V and the Group H were 41.67%, 58.33%, 66.67%, but Differences among the groups were not statistically significant.2. The CVVH doesn't affect the TNF-α, IL-6, HMGB-1, IL-10 level in septic shock patients, while the HP may decrease the level of blood TNF-α, HMGB-1, IL-10.3. Both the CVVH and the HP+CVVH can promote the recovery of organ function, and the HP+CVVH may has better effects.4. The HP+CVVH doesn't influence the function of blood coagulation,which indicating there are no significant adverse effects involved. |
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