Clinical application of hemoperfusion therapy combined with continuous venovenous hemofiltration in patients with sepsis

Objective To observe the clinical efficacy and safety of hemoperfusion (HP) therapy combined with continuous venovenous hemofiltration (CVVH) for patients with sepsis.Methods A total of 70 ICU patients meeting the sepsis criteria was selected to divide into two groups (group A and B,35 patients for each group) based on the random number table method.The patients in group A were treated in combination with CVVH on the basis of the medical treatment,and the ones in group B received combination of HP with CVVH on the basis of the medical treatment.Results In group A,the hypersensitivity C-reactive protein (hs-CRP),tumor necrosis factor a (TNF-a),interleukin 6 (IL-6) and calcitonin protoxin (PCT) and lipopolysaccharide (LPS) decreased in at 120h of treatment (P<0.05).In group B,the above indexes decreased at 72 h and 12 h of treatment,and the decrease for group A was more significant than that for group A (P<0.05).The mean arterial pressure (MAP) was improved in the two groups (P<0.05) at 120 h of treatment,but there was no significant difference between the two groups (P>0.05).In group B,at 120h of treatment,heart rate (HR),vasoactive-inotropic score (VIS),oxygenation index (OI),acute physiology and chronic health evaluation (APACHE Ⅱ) score and sequential organ failure assessment score (SOFA) were all decreased (P<0.05),and the decrease for group B was more significant than for group A(P<0.05).After treatment,the levels of blood serum creatinine (Scr) and total bilirubin (TBIL) decreased in both groups (P<0.05),but there was no significant difference between the two groups at the same time point.There was no significant difference in blood purification time,incidence of serious bleeding events and 28-day mortality rate between the two groups (P>0.05);and,ICU hospitalization time and mechanical ventilation time in group B were shorter than those in group A (P<0.05),and ICU mortality rate in group B was smaller than that in group A (P<0.05).Conclusions Compared to alone CVVH,HP therapy combined with CVVH for patients with sepsis can remove inflammatory mediators more effectively and improve organ functions and prognosis,with no significant increase in incidence of the complication of bleeding.