Combined Use Direct Endotoxin Absorption And High Volume Hemofiltration On The Influence Of Endothelial Cells

Sepsis and MODS is one of the major reason for the death of critical patients. Although the development of antibiotics and nursing has brought about the effective control for sepsis, the mortality of sepsis is still high. In clinical observation, we can find that there are obviously VEC dysfunction in sepsis patients.As we all know, the VEC is the largest organ, the dysfunction of VEC could influence the prognosis of the sepsis patients gravely.In recent years, CBP is unceasing enhancement and consummation, the clinical practical scope is expanding day by day. the indications of CBP were extending from critical renal diseases originally to several non-renal diseases nowadays. It has gained extraordinary progression. High volume hemofiltration (HVHF) was developed on the foundation of standard CRRT and was demonstrated that it was able to elevate the removal of large and middle molecular weight solute by increasing the input of replacement liquid.Accompanied with the development of continuous renal replacement therapy (CRRT) during Last 20 years, the indications of CRRT were extending from critical renal diseases originally to several non-renal diseases nowadays. It has gained extraordinary progression. High volume hemofiltration (HVHF) was developed on the foundation of standard CRRT and was demonstrated that it was able to elevate the removal of large and middle molecular weight solute by increasing the input of replacement liquid. Compared with CBP, HVHF shows to improve the hemodynamics status more obviously, decrease the dosage of positive inotropic, down-regulate inflammatory reaction and recover the immunity balance and improve the cure rate. and the PMX-F system has the sterilization and center the endotoxin dual function, so HVHF combined to PMX-F could play the effect that traditional medicines can not match.Objective:Inducing animal model in sepsis with Escherichia coli endotoxin, and using high volume hemofiltration (HVHF)to treat animal model, to evaluate the influences of hemoperfusion on sepsis, and to provide experimental bases for using it to treat severe injure patients as an assisted method.Methods:(1)Model making:twenty dogs were randomly divided into 4 groups:control group, model group, HVHF group and HVHF combined PMX-F group (5 for each group).Besides control group,three groups were infused i.v. endotoxin lmg/kg (2) Construction of pump:A peristaltic blood pump with a blood flow rate of 150-180ml/ min and with bicarbonate based dialysate were selected. Fluid balance was controlled with a continuously displayed on the control panel. (3)Blood samples were collected from all animals before endotoxin infusion (T1,baseline) and at 60(T2),120(T3),240(T4), 480min(T5), after endotoxin infusion. The dynamic change of ET,vWF,LPS and so on. HR, MAP were measured, calculated and recorded at T1-5.Results:(1)Once septic model was successfully constructed, there will be the typical bacteremia and the resultant systemic changes(2)In addition to the control group, the concentrations of ET,vWF and LPS of four group animals was increased significantly. After four hours of treatment,The concentrations of LPS and cytokines in peripheral blood decreased significantly after HF.(3)clinical improvement during HF were impressive in our patients. Mean arterial pressure was increased significantly.Heart. rate and respiratory rate were also reduced significantly.Conclusion:(1)the sepsis model could be successfully reproduced by endotoxin infusion and the model similar to clinical in induced factors, diagnostic criteria, function, pathological changes aspects, providing important technology platform for further study of the formation and development of sepsis.(2)In the treatment on sepsis, HF could regulate inflammatory response effectively,decreased the concentrations of LPS,ET and vWF HF could attenuate the circulating level of cytokines; improve major organ function; protect the function of endothelial cell.(3)the indications of CBP were extending from critical renal diseases originally to several non-renal diseases nowadays. It has gained extraordinary progression.