Effect Of Continuous Renal Replacement Therapy Started At Different Time On Patients With Sepsis

Objective: Sepsis and sepsis shock is the leading cause of death in critically illpatients. The United States Centers for Disease Control (CDC) statistics, every year751000people suffering from sepsis, in which215000people died. In recent decades,despite aggressive supportive treatment and care, sepsis and sepsis shock mortality rate isstill high. The overall hospital mortality in patients with sepsis in28.6%, and severe sepsisand septic shock patients case fatality rates were25%~30%and40%~70%, globaldeaths per1400people, treatment of patients with huge cost, accounting for40%ICUconsumption. Now CRRT has been widely applied in ICU of patients with sepsis treatment,people has recognized for the timing of the onset is also affecting the mortality factors, Butthe begainning of time in patients with sepsis in the application of CRRT therapy is still notclear. The purpose of this study aims to sepsis and septic shock stage in patients withCRRT treatment comparison, the observation of different timing of CRRT therapy forpatients with sepsis inflammatory index, hemodynamics, tissue perfusion and prognosticimplications, discussion on CRRT in patients with sepsis in the application of the besttreatment time, for the more reasonable sepsis treatment to accumulate more experience, toprovide basis for clinical therapy.Methods: A retrospective analysis of2010February to2012February Shandongprovincial Qianfo Hill hospital integrated parallel CRRT ICU treated patients with sepsis in81cases, according to the patients with CRRT therapy severity of illness for sepsis in21cases in CRRT group, control group19cases of sepsis, septic shock,22cases in groupCRRT, septic shock in19cases in the control group. All patients were collected beforetreatment, CRRT inflammatory indexes of white blood cell count (WBC), calcitonin (PCT),hemodynamic indices of heart rate (HR), mean arterial pressure (MAP), tissue and organ perfusion index blood lactic acid (Lac), oxygenation index (PaO2/FiO2), APACHE â…¡score dynamic changes and in patients with different prognosis.Results:(1) In CRRT group compared with the control group, body temperature (T),white blood cell count (WBC) and procalcitonin (PCT) before and after treatment werestatistically significant (P <0.05); sepsis septic shock in group CRRT than in groupCRRT had statistical significance (P <0.05). CRRT group compared with the controlgroup, heart rate (HR), mean arterial pressure (WAP) before and after treatment werestatistically significant (P <0.05), central venous pressure (CVP) after treatment toimprove overall, but there was no statistical significance (P>0.05), sepsis group CRRTthan in group CRRT treatment of septic shock good effect, but no significant difference (P<0.05). Septic shock in CRRT group than the control group in septic shock treatment after1,3,7days are more obvious advantages, lactic acid value (Lac) decreased significantly,there is statistical significance (P <0.05). After third days of treatment in sepsis groupCRRT lactic acid values were lower than1,5mmol/L, and septic shock in CRRT groupstill had50%patients lactate in1,5mmol/L above. While the oxygen index (PaO2/FiO2) and urine volume in sepsis and septic shock in CRRT group than in CRRT group,no significant difference (P>0.05).(2) in CRRT group than in the control group werestatistically significant (P <0.05), sepsis group CRRT after third days of treatment withAPACHE â…¡ score in a septic shock in CRRT group was significantly lower (P <0.05),and the sepsis group CRRT third days after treatment can reach in septic shock groupCRRT after seventh days of treatment outcomes, but no significant difference (P>0.05).And renal failure cases of CRRT group was significantly lower than the control group, andCRRT group was lower than that of sepsis septic shock group CRRT;28d7d and the casefatality rate is lower than the late group, but did not reach statistical significance (P>0.05).Conclusion: In the early phase of sepsis and septic shock stage, CRRT cansignificantly reduce the inflammation index, is accelerated in patients with hemodynamicstability, better able to improve patient tissue and organ perfusion, and in the early stage ofsepsis in CRRT therapy, a septic shock stage CRRT treatment, APACHE â…¡ score decreasedmore apparently, renal failure patients significantly decreased in patients with7d and28d,reduce mortality, improve the prognosis of the patients. Support in sepsis occurs early afterCRRT therapy.