The therapeutic effect of continuous blood purification on diabetic lactic acidosis / 中国糖尿病杂志

Objective To investigate the therapeutic effect of continuous blood purification on diabetic lactic acidosis(DLA).Methods 60 DLA patients who were treated at our hospital Blood Purification Center from January 2020 to January 2023 were randomly divided into conventional treatment group(Con)and continuous blood purification group(CBP),with 30 cases in each group.The changes of anion gap(AG),pH,lactic acid(Lac),FPG,2 hPG,HbA1c,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),serum creatinine(Scr),urea nitrogen(BUN),cystatin C(CysC),blood potassium(K+),C-reactive protein(C-RP),acute and chronic health evaluation scoring system Ⅱ(APACHEⅡ)and mortality within 28 days were compared between the two groups.Results After 48 h of treatment,the clearance rate of Lac in CBP group was higher than that in Con group(P<0.05).The pH value of CBP group was higher than Con group.The levels of AG,Lac,FPG,2 hPG,HbA1c,ALT,AST,TBIL,Scr,BUN,CysC,K+,C-RP and APACHEⅡ score were lower in CBP group than those in Con group(P<0.05).The 28-day mortality rate of the CBP group was lower than that of the Con group(P<0.05).Conclusion Continuous blood purification combined with routine treatment in DLA patients can increase Lac clearance and improve the prognosis.

Adsorptive Therapies in Sepsis and Inflammation: Description of the Various Adsorptive Techniques and their Failure to Improve Outcomes

ABSTRACT Blood purification as an adjunctive therapy has been studied for several decades. In this review, we will focus on the most recent studies, particularly on adsorption techniques. These include hemofilters with adsorptive membranes, both endotoxin-specific and non-specific. In addition, we will discuss sorbents that target endotoxins, as well as devices that non-selectively capture viruses and bacteria. For each technique, we will also explore the reasons why blood purification methods have thus far failed to improve survival. Conventionally, reasons for the lack of success in blood purification techniques have been attributed to the need for better patient stratification through bedside measurements of interleukins and endotoxins. The choice of assay is also crucial, with endotoxin activity assays being preferable to other forms of limulus amoebocyte lysate assays. Another critical factor is timing, as administering blood purification at the wrong moment can potentially harm the patient. Mechanistic studies are still lacking for most devices, leaving us to treat patients blindly, except in endotoxin cases. In the context of viruses, especially COVID-19, we require a deeper understanding of the complexities involved in viral replication, as this could significantly impact the efficacy of blood purification techniques. The failures highlighted for each device should be viewed as potential areas for improvement. Despite the challenges, we remain hopeful that these techniques will eventually succeed and prove beneficial in the future.

Three cases of acute chlorfenapyr poisoning / 中华劳动卫生职业病杂志

This paper reported 3 cases of poisoning caused by chlorfenagyr. Chlorfenapyr poisoning has gradually increased in clinical practice. The early stage after poisoning is digestive tract symptoms, followed by sweating, high fever, changes in consciousness, changes in myocardial enzymology, etc. Its main mechanism of intoxication is uncoupling oxidative phosphorylation. Since there is no specific antidote after poisoning, the fatality rate of chlorfenapyr poisoning remains high. The therapeutic measures are early gastrointestinal decontamination, symptomatic and supportive treatments, and early blood purification may be an effective treatment.

Clinical analysis of respiratory depression caused by glufosinate poisoning / 上海预防医学

ObjectiveTo analyze the clinical features， treatment and prognosis of patients with respiratory depression caused by glufosinate poisoning. MethodsThe clinical data of patients with respiratory depression caused by glufosinate poisoning admitted to the ICU of Xiangshan first people’s hospital medical and health group from March 2018 to January 2022 were retrospectively analyzed. ResultsA total of 21 patients with respiratory depression caused by glufosinate poisoning were included. The median （interquartile） intake of glufosinate was 30 （20， 40） g， and the median （interquartile） visit time was within 2.0 （1.0， 2.8） h. The initial symptoms were nausea and vomiting in 16 cases （76.2%）， and sore throat in 8 cases （38.1%）. Respiratory depression， convulsions and shock occurred 6‒48 hours after ingestion of glufosinate. Convulsion occurred in 13 cases （61.9%）， shock in 10 cases （47.6%） and bradycardia in 5 cases （23.8 %）. Among the patients with convulsion or shock， respiratory depression occurred earlier than convulsion and shock in 10 cases （76.9%） and 9 cases （90.0%）， respectively. All patients were treated with gastric lavage， catharsis， mechanical ventilation and symptomatic support. Blood purification was performed in 14 cases. The duration of mechanical ventilation was 5.0 （4.0， 7.0） d，and no patient died. The patients were divided into blood purification group and routine treatment group. There was no significant difference in complications and duration of mechanical ventilation between the blood purification group and the routine treatment group （P>0.05）. ConclusionRespiratory depression caused by glufosinate poisoning usually occurs earlier than convulsion and shock. The overall prognosis of patients with respiratory depression caused by glufosinate poisoning is good， which mainly depends on the early recognition and intervention of respiratory depression.

Clinical Characteristics of Children with Hemophagocytic Syndrome with Different EB Virus DNA Loads / 中国实验血液学杂志

OBJECTIVE@#To analyze the clinical characteristics of hemophagocytic syndrome (HLH) children with different EB virus (EBV) DNA loads, and to explore the relationship between differential indicators and prognosis.@*METHODS@#Clinical data of 73 children with HLH treated in our hospital from January 2015 to April 2022 were collected. According to EBV DNA loads, the children were divided into negative group (≤5×102 copies/ml), low load group (>5×102-<5×105 copies/ml) and high load group (≥5×105copies/ml）. The clinical symptoms and laboratory indexes of the three groups were compared, and the ROC curve was used to determine the best cut-off value of the different indexes. Cox regression model was used to analyze the independent risk factors affecting the prognosis of children, and to analyze the survival of children in each group.@*RESULTS@#The proportion of female children, the swelling rate of liver and spleen lymph nodes and the involvement rate of blood, liver, circulation and central nervous system in the high load group were higher than those in the negative group. The incidence of disseminated intravascular coagulation(DIC) and central nervous system(CNS) involvement in the high load group were higher than those in the low load group. The liver swelling rate and circulatory system involvement rate in the low load group were higher than those in the negative group(P<0.05). PLT counts in the high load group were significantly lower than those in the negative group, and the levels of GGT, TBIL, CK-MB, LDH, TG, SF, and organ involvement were significantly higher than those in the negative group. The levels of CK, LDH, SF and the number of organ involvement in the high load group were significantly higher than those in the low load group. The levels of GGT and TBIL in low load group were significantly higher than those in negative group. In terms of treatment, the proportion of blood purification therapy in the high and low load group was significantly higher than that in the negative group(P<0.01). ROC curve analysis showed that the best cut-off values of PLT, LDH, TG and SF were 49.5, 1139, 3.12 and 1812, respectively. The appellate laboratory indicators were dichotomized according to the cut-off value, and the differential clinical symptoms were included in the Cox regression model. Univariate analysis showed that LDH>1139 U/L, SF>1812 μg/L, dysfunction of central nervous system, number of organ damage, DIC and no blood purification therapy were the risk factors affecting the prognosis of children (P<0.05); Multivariate analysis shows that PLT≤49.5×109/L and dysfunction of central nervous system were risk factors affecting the prognosis of children (P<0.05). Survival analysis showed that there was no significant difference in the survival rate among the three groups.@*CONCLUSION@#The incidence of adverse prognostic factors in children with HLH in the EBV-DNA high load group is higher, and there is no significant difference in the survival rate of the three groups after blood purification therapy. Therefore, early identification and application of blood purification therapy is of great significance for children with HLH in the high load group.

Clinical research on heparin monitoring blood purification:comparison of heparinase-modified thromboelastography versus activated partial thromboplastin time(APTT)in continuous renal replacement therapy for critically ill patients / 临床检验杂志

Objective To investigate the clinical values of heparinase-modified thromboelastography(hmTEG)in heparin monitoring during continuous renal replacement therapy.Methods A total of 97 cases who were undergoing continuous renal replacement therapy(CRRT)in the intensive care unit of the 94th People's Liberation Army Hospital from Jan 2014 to Jun 2019 were enrolled in this stud-y.The patients were divided into TEG group and APTT group according to different means of heparin monitoring during continuous renal replacement therapy.In total,278 hemofilters were used in all the blood purification therapies.Complication of bleeding,CRRT time,total heparin dose and SOFA(sequential organ failure assessment)score of the patients were compared between the TEG and APTT groups.The filter life span and survival time in hospital were also compared using Kaplan-Meier analysis.Rusults Compared with APTT group,the total heparin dose in TEG group were significantly higher(P＜0.05).The CRRT time of patients and the average filter life span in TEG group were significantly longer than those of APTT group(P＜0.05).Compared to APTT group,the 28-day SOFA in TEG group was significantly lower(P＜0.05).Survival analysis showed that the 28-day risk of death in the patients of APTT group was 2.01 times higher than that in TEG group(P＜0.05).The 72-hour filter life of TEG group was significantly longer than that of APTT group(P＜0.05).Conclusion The use of hmTEG for monitoring heparin in blood purification should be superior in terms of safety and efficacy with longer filter life span and higher survival rate of patients.

Anticoagulant effectiveness and safety evaluation of a modified heparin anticoagulant method in children treated with hemoperfusion / 中国中西医结合急救杂志

Objective To examine the anticoagulant effectiveness and safety of a modified heparin anticoagulant method with those of the standard hepair anticoagulant method in children treated with hemoperfusion,and to provide a basis for optimizing the anticoagulant protocol of hemoperfusion treatment.Methods Twenty-three children treated with a total of 41 sessions of hemoperfusion from June 2021 to February 2022 in Department of Pediatric Nephrology of West China Second Hospital of Sichuan University were selected as research objects by convenient sampling method.The participants were divided into a standard anticoagulation group and an improved anticoagulation method group according to the different heparin-anticoagulation schemes.A total of 11 children in the standard anticoagulation group received 19 sessions of hemoperfusion treatment using the standard heparin anticoagulation scheme,i.e,the first dose of 0.5-1.0 mg/kg heparin was given intravenously,5-10 minates before hemoperfusion,followed by continuous intravenous infusion of 0.2-0.5 mg·kg-1·h-1 heparin which was expected to be stopped 30 minutes before the ending of hemoperfusion.A total of 12 patients in the improved anticoagulation method group underwent 22 sessions of hemoperfusion treatment using an improved heparin anticoagulant method,i.e,intravenous injection 1 mg/kg of heparin before the start of treatment without additional administrations of heparin thereafter.The changes in activated partial thromboplastin time(APTT)at 30,60,90 minutes,and the end of treatment in two groups of children,as well as the coagulation status of the two groups of pipelines and filters,together with the bleeding situation of the children,were monitored.The differences in platelet count(PLT)and recovery of APTT 1 hour after treatment between the two groups of children were compared.Results Compared with the standard anticoagulation method,the improved anticoagulation method showed 68.8%lower APTT value exceeding 300 seconds[β =-1.166,odds ratio(OR)= 0.312,95%confidence interval(95%CI)was 0.125-0.775,P = 0.012]was safer than standard method,and both of them showed good anticoagulation effects at 30,60,90 minutes,and at the end of treatment.The anticoagulation effect of heparin was not influenced by sex(P = 0.179)as well as age(P = 0.821).The improved anticoagulation method group showed better APTT recovery 1 hour after treatment than the standard anticoagulation group(11/22 vs.3/19,P＜0.05).Both anticoagulation methods did not show any coagulation in the pipeline or filter during the treatment process,and the patient did not experience active bleeding within 24 hours after the end of treatment.Conclusion The improved anticoagulant method can achieve anticoagulant effectiveness comparable to that of standard anticoagulation method,is safer than standard method,and at the same time,simplifies the operational process,thereby could reduce the risk of blood borne infections.

Preoperative establishment and postoperative maintenance of vascular accesses for hemodialysis in kidney transplantation recipients / 中华器官移植杂志

A vast majority of renal transplant recipients receive hemodialysis prior to kidney transplantation(KT). Currently the commonly employed blood purification accesses include non-cuffed catheter(NCC), tunnel-cuffed catheter(TCC), autologous arteriovenous fistula(AVF)and arteriovenous graft(AVG). And the above four accesses types have their inherent advantages and disadvantages.In clinical practices, patients of end-stage renal disease(ESRD)are selected by vascular status, disease severity and expected duration of dialysis.However, no standard recommendation is available for selecting hemodialysis accesses for patients awaiting KT.Summarizing the latest researches in the field, this review compared the advantages and disadvantages of various hemodialytic accesses in conjunctions with the clinical characteristics of patients awaiting KT.The goal was to resolve the choices of selecting and maintaining hemodialysis access for patients awaiting KT.

Value of bedside high-flow continuous blood purificationcombined with Xuebijing in the treatment of severe sepsis / 中国医师进修杂志

Objective:To investigate the effect of bedside high-flow continuous blood purification (CBP) combined with Xuebijing in the treatment of severe sepsis (SS) and the influence on the patient′s coagulation-fibrinolysis index, immunity index and expression of peripheral blood Toll-like receptor 4 (TLR4).Methods:Ninety-three patients with SS who were admitted and treated in the Lianyungang First People′s Hospitalfrom January 2017 to October 2019 were selected. They were divided into the combined group (51 cases, treatment with bedside high-flow CBP and Xuebijing injection based on bundle therapy) and the control group (42 cases, treatment with Xuebijing injection based on bundle therapy). The changes in coagulation and fibrinolysis index, immunity index, biochemical index such as TLR4 before treatment and after 1 week of treatment were compared between the two groups. The incidences of complications in both groups were statistically analyzed, and the discharge time from ICU, mechanical ventilation time and 28-day mortality were recorded.Results:After 1 week of treatment, the levels of prothrombin time (PT) and activated partial thromboplastin time (APTT) in the two groups were shortened, D-dimer (D-D) and fibrinogen (FIB) were decreased ( P<0.05); and the levels of PT and APTT in the combined group were shorter than those in the control group, the levels of DD and FIB were lower than those in the control group, there were statistical differences ( P<0.05). After 1 week of treatment, the levels of CD 4+ and CD 4+/CD 8+ ratio in both groups were increased ( P<0.05), and the levels of CD 4+ and CD 4+/CD 8+ ratio in the combined group were higher than those in the control group ( P<0.05). After 1 week of treatment, the levels of TLR4, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), blood lactate (Lac), blood urea nitrogen (BUN) and serum creatinine (Scr) in both groups were decreased ( P<0.05), meanwhile, the above indexes in the combined group were lower than those in the control group ( P<0.05). The incidence of multiple organ failure and the 28-day mortality rate in the combined group were lower than those in the control group: 3.92%(2/51) vs. 19.05%(8/42), 13.73%(7/51) vs. 30.95%(13/42), there were statistical differences ( P<0.05). The discharge time from ICU and mechanical ventilation time in the combined group were shorter than those in the control group: (12.35 ± 2.14) d vs. (14.17 ± 3.36) d, (7.12 ± 2.23) d vs. (8.51 ± 2.39) d, there were statistical differences ( P<0.05). Conclusions:Bedside high-flow CBP combined with Xuebijing injection in the treatment of SS can improve the patient′s condition, regulate the balance of coagulation and fibrinolysis, avoide the activation of coagulation, inhibite inflammatory response, reduce the expression of TLR4 in peripheral blood, improve immune function, protecte kidney function and promotethe patient′s recovery.

Effect and safety of double plasma molecular absorption in treatment of patients with severe wasp stings injury: a multicenter historical cohort study / 中华危重病急救医学

Objective:To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.Methods:Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1∶1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.Results:After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE Ⅱ score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio ( HR) = 1.04, 95% confidence interval (95% CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature ( HR = 1.02, 95% CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95% CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95% CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE Ⅱ score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups. Conclusion:CVVH+DPMA+HP regimen can significantly reduce the APACHE Ⅱ score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.

A comparative study of the effects of citrate and heparin anticoagulation on coagulation function and efficacy in children with septic shock undergoing continuous blood purification / 中华危重病急救医学

Objective:To compare the effects of citrate and heparin anticoagulation on coagulation function and efficacy in children with septic shock undergoing continuous blood purification (CBP), and to provide guidance for CBP anticoagulation in children with septic shock.Methods:A case control study was conducted. Thirty-seven children with septic shock admitted to the pediatric intensive care unit (PICU) of the First Affiliated Hospital of Gannan Medical University from July 2019 to September 2022 were enrolled as the research subjects. The patients were divided into citrate local anticoagulation group and heparin systemic anticoagulation group according to different anticoagulation methods. The baseline data, the level of coagulation indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib), D-dimer] before treatment and 1 day after weaning from CBP, serum inflammatory mediators [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypersensitivity C-reactive protein (hs-CRP), procalcitonin (PCT)], bleeding complications during CBP and 7-day mortality were collected.Results:A total of 37 cases were enrolled finally, including 17 cases with citric acid local anticoagulation and 20 cases with heparin systemic anticoagulation. There was no statistically significant difference in general data such as gender, age, and body weight of children between the two groups. There were no statistically significant differences in baseline levels of coagulation indicators and inflammatory mediators before treatment of children between the two groups. One day after weaning from CBP, both groups showed varying degrees of improvement in coagulation indicators compared with those before treatment. Compared with before treatment, the PT of the heparin systemic anticoagulation group was significantly shortened after 1 day of weaning (s: 11.82±2.05 vs. 13.64±2.54), APTT and TT were significantly prolonged [APTT (s): 51.54±12.69 vs. 35.53±10.79, TT (s): 21.95±4.74 vs. 19.30±3.33], D-dimer level was significantly reduced (mg/L: 1.92±1.58 vs. 4.94±3.94), with statistically significant differences (all P < 0.05). While in the citrate local anticoagulation group, only APTT was significantly prolonged after treatment compared with that before treatment (s: 49.28±10.32 vs. 34.34±10.32, P < 0.05). There were no statistically significant differences in other coagulation indicators compared with before treatment. Compared with the citric acid local anticoagulation group, the PT of the heparin systemic anticoagulation group was significantly shortened after treatment (s: 11.82±2.05 vs. 13.61±3.05, P < 0.05), and the D-dimer level was significantly reduced (mg/L: 1.92±1.58 vs. 3.77±2.38, P < 0.01). The levels of inflammatory mediators in both groups were significantly reduced 1 day after CBP weaning compared with those before treatment [citric acid local anticoagulation group: hs-CRP (mg/L) was 12.53±5.44 vs. 22.65±7.27, PCT (μg/L) was 1.86±1.20 vs. 3.30±2.34, IL-6 (ng/L) was 148.48±34.83 vs. 202.32±48.62, TNF-α (ng/L) was 21.38±7.71 vs. 55.14±15.07; heparin systemic anticoagulation group: hs-CRP (mg/L) was 11.82±4.93 vs. 21.62±8.35, PCT (μg/L) was 1.90±1.08 vs. 3.18±1.97, IL-6 (ng/L) was 143.81±33.41 vs. 194.02±46.89, TNF-α (ng/L) was 22.44±8.17 vs. 56.17±16.92, all P < 0.05]. However, there was no statistically significant difference between the two groups (all P > 0.05). There was no statistically significant difference in bleeding complication during CBP and 7-day mortality in children between the citrate local anticoagulation group and the heparin systemic anticoagulation group (5.9% vs. 30.0%, 17.6% vs. 20.0%, both P > 0.05). Conclusions:Heparin for systemic anticoagulation and regional citrate anticoagulation can significantly reduce the levels of IL-6, TNF-α, hs-CRP and PCT in children with septic shock, and relieve inflammatory storm. Compared with citric acid local anticoagulation, heparin systemic anticoagulation can shorten the PT and reduce the level of D-dimer in children with septic shock, which may benefit in the prevention and treatment of disseminated intravascular coagulation (DIC).

Research progress on continuous blood purification in the treatment of severe acute pancreatitis / 中国医师杂志

Severe acute pancreatitis (SAP) is a common gastrointestinal disease, often accompanied by systemic inflammatory reactions and organ dysfunction. SAP has an acute onset, severe condition, rapid progression, and poor prognosis. The development of SAP is closely related to the excessive release of inflammatory factors. In the comprehensive treatment of SAP, continuous blood purification (CBP) can clear inflammatory mediators, improve the stability of Internal environment, improve organ function, reduce blood lipids, regulate immunity, and significantly improve the condition of SAP patients. It is an important means of treating SAP. This article reviews the research progress of CBP in the treatment of SAP.

Progress in the application of blood purification treatment mode in the treatment of wasp sting patients / 中国医师杂志

Wasp sting is a common emergency in mountainous areas of China, with rapid onset and progression, high mortality rate, and serious harm to public health. Wasp sting can cause mild local reactions in mild cases, and Anaphylaxis or even multiple organ dysfunction in severe cases, of which Acute kidney injury (AKI) is the most common and serious. Blood purification treatment is commonly used for wasp sting patients to maintain renal function, eliminate toxins, and maintain Internal environment stability. The commonly used clinical methods are Hemoperfusion (HP), plasma exchange (PE), and continuous renal replacement therapy (CRRT). At present, there is no clear recommendation for the blood purification treatment mode of wasp sting in China, and there is no clear guidance for its combined treatment mode. This article will review the single and combined use of blood purification treatment models for wasp stings, based on the latest clinical research.

Blood purification in critically ill children: a large single-center eight-year retrospective study / 中国小儿急救医学

Objective:To compare the characteristics of patients undergoing blood purification treatment in PICU of a children′s tertiary hospital during 8 years, so as to analyze the changes in the development of blood purification technology in children in East China.Methods:Patients who received blood purification treatment in PICU of Children′s Hospital of Fudan University from 2014 to 2021 were included and divided into two study periods: 2014-2017 and 2018-2021.The clinical characteristics and treatment parameters of patients were collected and analyzed.Results:A total of 1 029 patients were included in the study, of which 103 were combined with extracorporeal membrane oxygenation.The 28-day survival rate of 926 patients treated with pure blood purification was 55.7%.Among them, patients with younger age, lower body weight, using mechanical ventilation, using vasoactive drugs before blood purification, and patients with multiple organ dysfunction syndrome had a higher distribution in the death group than those in survival group( P<0.05). During 8 years, a total of 3 688 cases of blood purification were performed.The main mode was continuous veno-venous hemodiafiltration (CVVHDF) (68.6%), followed by therapeutic plasma exchange (TPE) (23.8%) and hemoperfusion (HP) (4.8%); the main indication was acute kidney injury (AKI) (29.3%), followed by severe inflammatory disease (26.2%) and acute liver failure (16.2%). Compared with 2014-2017, the number of blood purification treatments in 2018-2021 increased by 47.4%, and the survival rate of patients increased significantly (48.7% vs. 58.1%, P<0.05). The distribution of blood purification patterns and indications also changed( P<0.05). The proportions of TPE (20.5% vs. 26.0%) and HP (3.1% vs. 6.0%) increased, while the proportion of CVVHDF (71.9% vs. 66.4%) decreased significantly.The proportions of AKI (29.8% vs. 38.9%) and refractory immune diseases (8.4% vs. 15.2%) were significantly higher, while severe inflammatory diseases (29.2% vs. 24.2%) and acute liver failure (19.6% vs. 13.8%) had declined. Conclusion:From 2014 to 2021, the number of blood purifications performed in our center increased significantly.Although the distribution of indications and patterns have also changed significantly, the overall survival rate is significantly improved.However, standardized practice still needs to be strengthened.

Application of blood purification technology in children with acute and critical diseases / 中国小儿急救医学

Objective:To explore the scope, mode, anticoagulation mode and complications of blood purification in children with acute and critical illness.Methods:A total of 377 times of treatment of 102 children treated with blood purification in PICU at the First Affiliated Hospital of Xinxiang Medical College from January 2018 to December 2020 were retrospectively analyzed.Results:Among 102 critically ill children treated with blood purification, acute and chronic renal failure ranked the first in terms of disease distribution, with 23 cases in total, followed by 16 cases of severe viral encephalitis (meningoencephalitis), 11 cases of septic shock, seven cases of acute poisoning, five cases of severe allergic purpura, five cases of necrotic encephalopathy.In terms of clinical prognosis, 51(50.0%) cases were cured, 29(28.4%) cases were improved, 10(9.8%) cases died, and 12 cases abandoned treatment.In 2019, the blood purification application frequency was the highest, with a total of 47 cases, which was higher than those in 2018 and 2020( P<0.05). Continuous veno-venous hemofiltration was used in the largest number of children, with a total of 56 cases.There was a statistically significant difference in the application ratio of this mode during 3 years ( P<0.05), while there was no statistically significant difference in the application ratio of other modes.In terms of the selection of anticoagulation methods, the proportions of systemic anticoagulation and extracorporeal anticoagulation had significantly difference among different years( P<0.05), and the application of extracorporeal anticoagulation had increased year by year.There was no statistically significant difference in the proportion of patients without anticoagulants.The incidence of complications of blood purification was the highest in 2019, with catheter related thrombus in the majority (30 person-times), followed by hypothermia, catheter filter coagulation, hematoma formation, catheter related infection, hypotension, heparin-induced thrombocytopenia, etc.There was statistically significant difference in the total complications among different years( P<0.05). Conclusion:Blood purification is widely used in children with acute and critical illness, with a variety of diseases.The most commonly used mode is continuous veno-venous hemofiltration and in vitro anticoagulation.Catheter-related thrombosis is the most common complication.

What Did We Learn about Coronavirus Disease-19-Associated Acute Kidney Injury During the Pandemic?

ABSTRACT Initial reports suggested that kidney involvement after coronavirus disease 19 (COVID-19) infection was uncommon, but this premise appears to be incorrect. Acute kidney injury can occur through various mechanisms and complicate the course of up to 25% of patients with COVID-19 hospitalized in our Institution, and of over 50% of those on invasive mechanical ventilation. Mechanisms of injury include direct kidney injury and predominantly tubular, although glomerular injury has been reported, and resulting from severe hypoxic respiratory failure, secondary infection, and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of progressive kidney damage and, in some cases, the use of renal replacement therapy. Although the use of blood purification techniques has been proposed as a potential treatment, results to date have not been conclusive. In this manuscript, the mechanisms of kidney injury by COVID-19, risk factors, and the mainstays of treatment are reviewed.

Meta analysis and systematic review of influencing factors on unplanned shutdown of continuous blood purification / 中国小儿急救医学

Objective:To systematically evaluate the influencing factors on unplanned shutdown of continuous blood purification, and to provide reference basis for the prevention of unplanned shutdown.Methods:The literatures related to the influencing factors of unplanned shutdown of continuous blood purification in CNKI, Wanfang Database, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Full-text Database, PubMed and Web of Science were searched.The retrieval time of Chinese database was from the establishment of the database to March 2021.English databases were searched from March 2016 to March 2021.Literature selection, quality evaluation and data extraction were independently conducted by two researchers, and Meta-analysis was performed by Stata 14.0 software.Results:A total of 11 studies were included, including 3 031 cases of continuous blood purification treatment and 1 412 cases of unplanned discontinuation.The combined OR value and 95% CI of all influencing factors were as follows: treatment mode 2.22 (1.06-4.62), blood flow velocity 0.91 (0.776-1.09), agitation 4.54 (2.33-8.86), ventilator 2.67 (1.63-4.38), transfusing blood products and fat milk 1.07 (0.34-3.36), one-time catheter success 0.26 (0.05-1.42), catheterization site (femoral vein vs.jugular vein) 2.24 (0.83-6.02). Conclusion:Unplanned deplaning is influenced by many factors.Treatment mode, agitation and ventilator use are the risk factors for unplanned deplaning.There is no correlation between blood flow velocity, transfusing blood products and fat milk, one-time catheterization success, catheterization site and unplanned deplaning.

Application strategies of continuous blood purification in pediatric patients with cerebral edema / 中国小儿急救医学

Continuous blood purification(CBP)has been extensively used in pediatric critical care and proven effective in pediatric patients with cerebral edema.However, as a causative factor of changes in blood pressure, blood volume, plasma osmotic pressure, and drug metabolism, CBP may have reduced efficacy and even exacerbate the cerebral edema when pediatric patients are provided with inadequate clinical evaluation and intervention or inappropriate settings of treatment parameters.This paper presented a literature review on the application strategies of CBP as a treatment of pediatric patients with cerebral edema to provide a reference for clinical practice.

Clinical application of blood adsorption / 中国小儿急救医学

Blood adsorption, one of the blood purification, can be classified into hemoperfusion and immunoadsorption.In recent years, double plasma molecular adsorption, a combined adsorption, has also been widely used in clinical practice.Based on adsorption, the toxins in blood of patients can be efficiently removed by hemoadsorbents.There are two kinds of adsorbents commonly used in hemoperfusion: carbon and resin, and two types of adsorbents in immunoadsorption: biological affinity and physicochemical affinity.Adsorption has been widely applied in clinical practice, involving in sepsis, organ transplantation, systemic lupus erythematosus, liver failure, autoimmune diseases and so on.The review described the application of blood adsorption in clinical practice.

The efficacy of continuous blood purification in the treatment of severe heart failure combined with renal failure / 中国医师进修杂志

Objective:To explore the clinical value of continuous blood purification(CBP) in patients with severe heart failure combined with renal failure and its effect on serum p66Shc protein, soluble fms-like tyrosine kinase receptor 1 (sFlt-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1).Methods:Ninety-seven patients with severe heart failure combined with renal failure admitted to the Chaoyang Central Hospital from March 2017 to October 2019 were enrolled and they were divided into the control group (48 cases) and the observation group (49 cases) according to the random number table method. The control group was treated with intermittent hemodialysis (IHD), while the observation group was treated with CBP. Changes of the efficacy, the renal function indexes, cardiac function indexes, p66Shc protein, sFlt-1, TIMP-1 before and after treatment were compared between the two groups. The occurrence of adverse reactions were recorded.Results:The total effective rate in the observation group was better than thatin the control group: 79.59% (39/49) vs. 60.42% (29/48), χ 2 = 4.25, P<0.05. After treated for 1 week, the levels of blood urea nitrogen, serum creatinine, serum phosphorus, blood uric acid and β2 microglobulinin the observation group were lower than those in the control group: (12.63 ± 3.14) mmol/L vs. (16.23 ± 4.74) mmol/L, (175.52 ± 39.57) μmol/L vs. (240.15 ± 50.18) μmol/L, (1.20 ± 0.23) mmol/L vs. (1.37 ± 0.31) mmol/L, (265.15 ± 34.79) μmol/L vs.(297.52 ± 50.07) μmol/L, (28.75 ± 5.14) mg/L vs. (33.52 ± 7.39) mg/L, the differences were statistically significant ( P<0.05). The levels of left ventricular ejection fraction, cardiac output and stroke volume in the observation group were higher than those in the control group: (53.63 ± 7.96)% vs. (49.52 ± 5.14)%, (58.45 ± 15.23) ml vs. (49.58 ± 9.52) ml, (4.59 ± 0.52) L/min vs. (4.01 ± 0.23) L/min, the differences were statistically significant ( P<0.05). The levels of p66Shc, sFlt-1, TIMP-1 in the observation group were lower than thosein the control group: 1.11 ± 0.36 vs. 1.45 ± 0.42, (15.76 ± 4.34) μg/L vs. (19.87 ± 5.66) μg/L, (59.14 ± 10.57) μg/L vs. (65.39 ± 9.45) μg/L, the differences were statistically significant ( P<0.05). The total adverse reaction rate in the observation group was lower than that in the observation group: 14.29% (7/49) vs. 31.25% (15/48), χ2 = 3.98, P<0.05. Conclusions:CBP therapy for patients with severe heart failure combined with renal failure has better efficacy than IHD, and can improve the patient′s cardiac and kidney function, reduce the levels of p66Shc protein, sFlt-1 and TIMP-1, reduce adverse reactions. It is safe and feasible.