Objective To investigate the efficacy of continuous blood purification ( CBP) in the treatment of severe sepsis, and explore the related immune regulatory mechanisms. Methods Forty-eight patients with severe sepsis were randomly divided into a control group ( n =23) and a CBP group ( n =25) .CD4 + CD25 + regulatory T cells ( Treg% ) in peripheral blood and APACHEⅡ score were measured dynamically before treatment and 12, 24, 36, 48, 60, 72 hours after treatment. Meanwhile the length of ICUstay, duration of mechanical ventilation, and 28 day mortality were determined. Results Compared with the control group, the length of ICU stay, ventilator time, incidence of multiple organ failure, and mortality decreased significantly in the CBP group ( P lt; 0. 05) . And CBP also decreased Treg% and APACHEⅡ score significantly. There was a positive correlation between Treg% and APACHEⅡ score ( r =0. 804, P lt;0. 01) .Conclusion Early CBP treatment can reduce Treg%, improve cellular immunity and improve the prognosis of sepsis.
目的:提高群蜂蛰伤致急性肾衰竭(ARF)的诊断和治疗水平。方法:回顾性分析我科7年来收治的23例群蜂蛰伤致ARF的临床资料,初步探讨其疗效及死因等。结果:23例群蜂蛰伤致急性肾功能衰竭患者,少尿型ARF为20例(占87%)无尿型ARF为3例(占13%);均伴有心肌酶、肌酸激酶、乳酸脱氢酶、谷丙转氨酶(ALT)升高;主要并发症为中毒性心肌炎(23/23,1000%)、横纹肌溶解肌症(23/23,1000%)、血红蛋白尿(21/23,913%)、血管内溶血(21/23,913%)、中毒性肝炎(16/23,696%)等;入院后12h内,10例行血液透析(hemodialysis,HD),13例行血液灌流(hemoperfusion,HP)/透析联合治疗(HP/HD);两组患者总治愈好转率为870%,病死率为130%;其中HD组治愈好转率为700%(7/10),病死率为30%(3/10),HP/HD组治愈好转率为100%(13/13),病死率为0,两组间疗效存在显著差异(P=0034);但所观察的病例中,HD组为我科前3年治疗蜂毒致ARF的方案,HP/HD组为我科后4年主要治疗蜂毒致ARF的方案,组间存在时间差异,并且病例数亦较少,因此两组的疗效对比有待进一步研究。3例患者死亡原因为多系统脏器功能衰竭(MSOF)。结论:蜂毒中毒所致急性肾功能衰竭以少尿型为主,同时伴有心、肝、血液、神经系统等重要组织器官的损伤,病情重;患者主要死亡原因为全身多系统器官功能衰竭(MSOF);尽早行血液净化是治疗群蜂蛰伤有效手段,其中条件允许的医院建议首选HP/HD联合治疗。
With the deepening of current study and the innovation of perioperative management concept, there have been great advances in lung transplantation in recent years. The prognosis of patients has been significantly improved. At the same time, the role of various types of blood purification in the clinical monitoring and treatment of lung transplant patients is becoming increasingly prominent. This review aims to summarize the application and latest progress of in vitro blood purification such as renal replacement therapy, plasmapheresis and hemadsorption in the perioperative period of lung transplantation, and to provide a basis for further study.
Severe bee stings can trigger a systemic inflammatory response and multi-organ dysfunction, potentially resulting in fatality. Acute kidney injury (AKI) is a frequent complication in patients with severe bee stings, and conventional comprehensive treatment combined with various blood purification therapies is commonly employed in clinical practice to promptly manage the condition and reduce the average hospital stay duration. This article primarily delves into the significance of enhanced clinical nursing care for patients with bee stings-induced AKI undergoing blood purification therapy. Specifically, it underscores the importance of patient education regarding treatment-related considerations, nursing techniques for vascular access during treatment, potential complications, and corresponding nursing interventions.
In recent years, Regional citrate anticoagulation (RCA) technology has been widely used not only in adult blood purification, but also in children’s blood purification, and its advantages in patients with high bleeding risk, active bleeding and heparin-induced thrombocytopenia have been repeatedly confirmed. Therefore, this article reviews and analyzes the application of RCA in different blood purification modes at home and abroad in recent years. It is found that its anticoagulation is not only safe and effective, but also can prolong the life of filter and reduce bleeding complications, which is suitable for the practice of blood purification.
Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.
Patients with severe acute kidney injury (AKI) often need renal replacement therapy (RRT）with a high morbidity and mortality. For patients with chronic renal failure, the aim of blood purification is renal replacement; but for patients with AKI, although customarily called RRT, the aim of blood purification is not “renal replacement”, but extracorporeal “renal support and protection”, that is, supporting and protecting temporally failed kidney, removing damage factors, avoiding renal reinjury and looking forward to restore renal function. This article provides a detailed explanation of the differences between renal replacement and renal support from the perspective of organ protection, as well as the key links of RRT and extracorporeal multiple organ support for patients with severe AKI.
During the medical rescue after Wenchuan earthquake, based on the design and implementation of the management process of blood purification equipment, we gave the top priority to those patients with post-disaster crush syndrome to ensure their hemodialytic treatment. Through strict management of blood purification technology, the outcomes of these patients have been fundamentally improved and the incidence of complications was substantially reduced. Safe and effective hemodialytic treatment have been administered to 77 patients with crush syndrome (813 case-times).
End-stage renal disease is a late complication of chronic kidney disease (CKD) and one of the leading causes of high mortality worldwide. Over the years, the impacts of gut microbiota and their associated uremic toxins on kidney diseases through the intricate “gut-kidney axis” have been extensively studied. However, translation of microbiome-related omics results into specific mechanisms is still a significant challenge. In this paper, we review the interaction between gut microbiome and blood purification, as well as the current microbiota-based therapies in CKD. Additionally, the current sequencing technologies and progresses in the gut microbiome research are also discussed.