Efficacy And Mechanism Of Continuous Blood Purification In The Treatment Of Severe Sepsis In Children

ObjectiveTo investigate the cardiovascular function,brain function,renal function,tissue perfusion,inflammatory index and internal environment after continuous blood purification(CBP)treatment in children with severe sepsis in intensive care unit(ICU).To evaluate the efficacy and mechanism of CBP in the treatment of severe sepsis in children.MethodsUsing the experimental research strategy,42 patients with severe sepsis admitted to the Pediatric Intensive Care Unit of Luoyang Women and Children Medical and Health Center from March 1,2017 to February 28,2019 were enrolled in the study.According to the parentsundefined desire to treat,on the basis of the same treatment condition,30cases in the purification group were treated with CBP,and 12 cases in the control group were given the routine treatment without CBP treatment.The changes of cardiovascular function,brain function,renal function,tissue perfusion,inflammatory index,internal environment,child critical case score and mortality before and after treatment were observed at the time of admission and 72 hours after treatment in the two groups.The independent sample t test was used for statistical analysis.Results(1)Cardiovascular function:Heart rate[mean difference before and after treatment=(48.112±21.129)times/min],The mean value of mean arterial pressure[post-treatment-pre-treatment difference=(12.109±5.003)mmHg]and BNP[pre-treatment-post-treatment difference average=(13376.129±7658.236)ng/L]in the purified group were significantly higher than those in the control group,heart rate[mean difference before and after treatment=(24.043±17.443)times per minute],Mean arterial pressure[mean post-treatment-pre-treatment difference=(6.192±3.612)mmHg]and BNP[pre-treatment-post-treatment difference mean=(7973.008±4676.451)ng/L].The difference was statistically significant(all P<0.05).(2)Organ dysfunction:Oxygen index[mean difference between post-treatment and pre-treatment=(120.571±67.702)mmHg]and mean 24-hour urine volume[mean difference between post-and pre-treatment=(1.650±0.141)ml/kg.h]in the purification group,Blood urea nitrogen[mean difference before and after treatment=(12.391±6.114)mmol/L],Serum creatinine[mean pre-and post-treatment difference=(82.706±26.572)umol/L]and Glasgow coma score[post-treatment-pre-difference mean=(6.571±2.009)]were significantly higher than those in the control group[treatment],Mean after-before treatment of oxygen index=(69.907±58.590)mmHg],The 24-hour mean urine volume[mean difference between post-treatment and pre-treatment=(0.850±0.745)ml/kg.h]and blood urea nitrogen[mean difference before and after treatment=(4.709±4.223)mmol/L].Serum creatinine[mean difference before and after treatment=(56.778±31.356)umol/L]and Glasgow coma score[mean difference after treatment-pre-treatment=(3.809±3.443)]were significantly increased.The difference was statistically significant(all P<0 05).(3)Tissue perfusion:CRT in the purified group[mean difference before and after treatment=(4.509±2.112)seconds],The mean values of blood lactic acid[pre-and post-treatment difference=(5.213±2.990)mmol/L]and central venous oxygen saturation[post-treatment-pre-treatment difference=(14.664±7.006)%]were significantly higher than those in the control group before and after treatment with CRT[mean difference between pre-and-post-treatment=(2.235±1.897)seconds],Blood lactic acid[mean difference before and after treatment=(2.148±1.093)mmol/L]and central venous oxygen saturation[mean difference after treatment and before treatment=(9.239±5.102)%]were significantly increased(P<0.05).(4)Inflammation index:Leukocyte count[mean difference before and after treatment=(11.120±5.361)×10~9/L],Platelet[mean difference before and after treatment=(209.112±56.698)×10~9/L]and C-reactive protein[mean difference before and after treatment=(136.341±100.701)mg/L],The mean value of procalcitonin[pre-treatment-post-treatment difference=(55.306±23.980)ug/L]and IL-6[pre-treatment-post-treatment difference average=(2.097±1.045)ug/L]in the purified group were significantly higher than those of the control group,The mean value of the latter value=(4.009±3.767)×10~9/L],Platelet[mean difference before and after treatment=(67.110±26.358)×10~9/L]and C-reactive protein[mean difference before and after treatment=(32.222±28.319)mg/L],The mean value of procalcitonin[pre-and post-treatment difference=(23.006±13.022)ug/L]and IL-6[pre-treatment-post-treatment difference mean=(0.808±0.522)ug/L].The difference was statistically significant(P<0.05).(5)Prognosis determination:The score of critically ill children in the purification group was significantly higher than that in the control group(26.071±8.845 vs 9.769±5.436,P<0.01).(6)All the indexes in the purification group were significantly improved after treatment compared with those before treatment,and the difference was statistically significant(all P<0.05).ConclusionsCBP can improve cardiovascular function,brain function,renal function,tissue perfusion,inflammation index,internal environment,and improve the score of children with severe sepsis.