| ObjectiveThe aim of this study was to evaluate the effect of the continuous blood purification on endothelium function in patients with MODS. To study the impact of CBP on endothelium function of patients with MODS from basic level. Provide theoretical support for further therapy, to improve the survival rate,1-ower mortality Clinically, finally Promote the continuous blood purification trea tment and the promotion of the scope of the treatment level.MethodsSelect thirty patients with MODS who receive CBP therapy in our hospital in 2007.1-2007.12.Five of them have obvious evidence of infection, includi ng three patients with calculus.eight patients with MODS caused by heart disea se.three patients with Severe acute pancreatitis.All patients Implant temporary e xtremity femoral vein catheter. Continuous venous-venous filtration therapy lastfor 24 hours.the replacement liquid formulation come form Nanjing Military Region General Hospital. Replacement fluid volume is 6000ml/h,before dilutio n enter is 4000ml/h, after dilution enter is 2000ml/h, blood flow is 250-300 ml/min. we use Low Molecular Heparin for anticoagulation, but patients with blooding tendency use non-heparinized CBP.we change filter after 12 hours tre atment,and then continue the therapy.Take 5ml elbow blood at the time of Oh ,3h, 6h, 12h, 24h during CBP therapy, 2000 round/min, centrifuged 10 minu tes, collecting the supernatant,-70℃refrigerator to preserve to be measured. Me asure electrolyte, liver function, renal function, blood gas analysis and so on, in accordance with the test results at any time adjust fluid replacement formul a. Record patients' respiration, blood pressure, heart rate and other vital signs and close observation of patients with signs of the spirit of the nervous syste m changes every 30 minutes. Measure APACHEⅡscore and observe changesin patients at any time needed. Select 30 people as healthy controls at the sa me period, take elbow vein blood 5ml, centrifugal blood and preservation it th e same as patients with MODS method.Measure patients' E-select,ICAM, V CAM, PAF-AH, using ELISA method.compare the different between them an d the healthy people.Resultspatients with MODS have higher level in E-select, ICAM,VCAM (27.03±14.49 VS 278.12±63.88, 370.63±111.15 VS 1499.86±660.44, 549.95±138.70 VS 905.51±265.15) ,and have low level in PAF-AH (19.92±6.16 VS 4.91±2.52) . with CBP therapy there are 19 patients still alive after 14 days about 63.6%,a nd 17 alive after 28 days about 56.7%. E-select, ICAM, VCAM's level drop obviously, especially after 12 hours we changed the filters.PAF-AH grow all t he time.patients died in 28 days have few change in Cytokines.patients live a fter 28 days have much more reduce in E-select, ICAM, VCAM level(274.88±73.85 VS 227.76±54.54,1432.23±773.23S VS 1011.17±355.50,842.78±304.49 VS 712.03±254.49),PAF-AH increase more obviously (4.72±2.40 VS 28.94±2. 25).compared with healthy people, E-select, ICAM VCAM, have decreased b ut can't drop to general level.PAF-AH can increase much more than general le vel.After CBP therapy patients' Electrolyte, Biochemical examination, become much better.Conclusion①patients with MODS have dramatic dysfunction in endothelium, patients who's endothelium are seriously injured have poor prognosis.②CBP treatment can clear cytokines that are harmful to MODS patients a nd protect vascular endothelial cell.③CBP therapy can improve the local environment of patients with MODS and reconstruct body's immune system.④The factors related to death in patients with MODS are various,compre hensive and systematic treatment of patients have good prognosis.
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