Abstract：
OBJECTIVE: To investigate the clinical efficacy of continuous veno-venous hemodia-filtration (CVVHDF) combined with hemoperfusion (HP) HA380 in the treatment of heat stroke patients with multiple organ dysfunction syndrome (MODS).
METHODS: A retrospective and observational study was conducted. A total of 15 patients with heat stroke combined with MODS who were admitted to the department of intensive care unit (ICU) of Suizhou Central Hospital/Hubei University of Medicine from July to September 2022 were selected as the study objects. All 15 patients were treated with CVVHDF combined with HA380 based on the comprehensive management strategy for severe illness. Organ function indicators [including total bilirubin (TBil), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), creatinine (Cr), cardiac troponin T (cTnT), myoglobin (Myo), MB isoenzyme of creatine kinase (CK-MB), sequential organ failure assessment (SOFA)] and inflammatory indicators [including white blood cell count (WBC), neutrophil count (NEU), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)] were collected. The improvements of the above indexes at admission, after the first HP, after the second HP, after the third HP, and on the 5th day of treatment were compared. Combined with the clinical outcome of patients, the comprehensive efficacy of CVVHDF combined with HA380 in the treatment of severe heat radiation disease was evaluated.
RESULTS: There were 10 males and 5 females among the 15 patients. The average age was (64.5±11.5) years old. There were 6 cases of classical heat stroke and 9 cases of exertional heat stroke. Glasgow coma scale (GCS) was 3-8 at admission; SOFA score was 9-17 within 12 hours after admission; acute physiology and chronic health evaluation II (APACHE II) was 25-45 within 24 hours after admission. After treatment, the IL-6 level and SOFA score gradually decreased, and there were significant differences in the decrease after the second HP compared to admission [IL-6 (ng/L): 48.37 (15.36, 113.03) vs. 221.90 (85.87, 425.90), SOFA: 8.3±3.3 vs. 11.1±2.4, both P < 0.05]. The PCT level reached its peak after the first HP [12.51 (6.07, 41.65) μg/L], and then gradually decreased, and the difference was statistically significant after the third HP [1.26 (0.82, 5.40) μg/L, P < 0.05]. Compared those at admission, Cr level significantly improved after the first HP (μmol/L: 66.94±25.57 vs. 110.80±31.13, P < 0.01), Myo significantly decreased after the second HP [μg/L: 490.90 (164.98, 768.05) vs. 3 000.00 (293.00, 3 000.00), P < 0.05], After the third HP, the CK level also showed significant improvement [U/L: 476.0 (413.0, 922.0) vs. 2 107.0 (729.0, 2 449.0), P < 0.05]. After CVVHDF combined with 3 times HP treatment, the patient\'s inflammatory response was gradually controlled and organ function gradually recovered. On the 5th day of the disease course, WBC, PCT and IL-6 levels were significantly improved compared to admission, and AST, CK, LDH, Cr, Myo, CK-MB, and SOFA score were significantly corrected compared with those on admission. The 24-hour survival rate of 15 patients was 86.67%, and the 24-hour, 7-day and 28-day survival rates were both as high as 73.33%. The average mechanical ventilation time of 11 surviving patients was (101.8±22.0) hours, the average continuous renal replacement therapy (CRRT) time was (58.8±11.0) hours, the average length of ICU stay was (6.3±1.0) days, and the average total hospitalization was (14.6±5.2) days.
CONCLUSIONS: CVVHDF combined with HP HA380 in the treatment of heat stroke patients with MODS can effectively improve organ function and alleviate the inflammatory storm, which is an effective means to improve the rescue rate and reduce the mortality of severe heat stroke patients.
METHODS: A retrospective and observational study was conducted. A total of 15 patients with heat stroke combined with MODS who were admitted to the department of intensive care unit (ICU) of Suizhou Central Hospital/Hubei University of Medicine from July to September 2022 were selected as the study objects. All 15 patients were treated with CVVHDF combined with HA380 based on the comprehensive management strategy for severe illness. Organ function indicators [including total bilirubin (TBil), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), creatinine (Cr), cardiac troponin T (cTnT), myoglobin (Myo), MB isoenzyme of creatine kinase (CK-MB), sequential organ failure assessment (SOFA)] and inflammatory indicators [including white blood cell count (WBC), neutrophil count (NEU), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)] were collected. The improvements of the above indexes at admission, after the first HP, after the second HP, after the third HP, and on the 5th day of treatment were compared. Combined with the clinical outcome of patients, the comprehensive efficacy of CVVHDF combined with HA380 in the treatment of severe heat radiation disease was evaluated.
RESULTS: There were 10 males and 5 females among the 15 patients. The average age was (64.5±11.5) years old. There were 6 cases of classical heat stroke and 9 cases of exertional heat stroke. Glasgow coma scale (GCS) was 3-8 at admission; SOFA score was 9-17 within 12 hours after admission; acute physiology and chronic health evaluation II (APACHE II) was 25-45 within 24 hours after admission. After treatment, the IL-6 level and SOFA score gradually decreased, and there were significant differences in the decrease after the second HP compared to admission [IL-6 (ng/L): 48.37 (15.36, 113.03) vs. 221.90 (85.87, 425.90), SOFA: 8.3±3.3 vs. 11.1±2.4, both P < 0.05]. The PCT level reached its peak after the first HP [12.51 (6.07, 41.65) μg/L], and then gradually decreased, and the difference was statistically significant after the third HP [1.26 (0.82, 5.40) μg/L, P < 0.05]. Compared those at admission, Cr level significantly improved after the first HP (μmol/L: 66.94±25.57 vs. 110.80±31.13, P < 0.01), Myo significantly decreased after the second HP [μg/L: 490.90 (164.98, 768.05) vs. 3 000.00 (293.00, 3 000.00), P < 0.05], After the third HP, the CK level also showed significant improvement [U/L: 476.0 (413.0, 922.0) vs. 2 107.0 (729.0, 2 449.0), P < 0.05]. After CVVHDF combined with 3 times HP treatment, the patient\'s inflammatory response was gradually controlled and organ function gradually recovered. On the 5th day of the disease course, WBC, PCT and IL-6 levels were significantly improved compared to admission, and AST, CK, LDH, Cr, Myo, CK-MB, and SOFA score were significantly corrected compared with those on admission. The 24-hour survival rate of 15 patients was 86.67%, and the 24-hour, 7-day and 28-day survival rates were both as high as 73.33%. The average mechanical ventilation time of 11 surviving patients was (101.8±22.0) hours, the average continuous renal replacement therapy (CRRT) time was (58.8±11.0) hours, the average length of ICU stay was (6.3±1.0) days, and the average total hospitalization was (14.6±5.2) days.
CONCLUSIONS: CVVHDF combined with HP HA380 in the treatment of heat stroke patients with MODS can effectively improve organ function and alleviate the inflammatory storm, which is an effective means to improve the rescue rate and reduce the mortality of severe heat stroke patients.
摘要：
目的：探讨持续静脉-静脉血源滤过(CVVHDF)联合血液灌流(HP)HA380治疗中暑合并多器官功能障碍综合征(MODS)患者的临床疗效。
方法：进行回顾性观察性研究。选取2022年7-9月湖北医药随州市中心医院重症监护病房(ICU)收治的15例中暑合并MODS患者作为研究对象。15例患者均采用CVVHDF联合HA380进行重症综合治疗。器官功能指标[包括总胆红素（TBil），天冬氨酸转氨酶（AST），肌酸激酶（CK），乳酸脱氢酶（LDH），肌酐(Cr),心肌肌钙蛋白T(cTnT),肌红蛋白(Myo),肌酸激酶同工酶（CK-MB），序贯器官衰竭评估（SOFA）]和炎症指标[包括白细胞计数（WBC），中性粒细胞计数（NEU），C反应蛋白(CRP),降钙素原(PCT),和白细胞介素-6（IL-6）]被收集。录取时上述指标的改善，在第一个HP之后，在第二个HP之后，在第三个HP之后，并在治疗第5天进行比较。结合患者的临床转归,评价CVVHDF联合HA380治疗重症热辐射疾病的综合疗效。
结果：15例患者中男性10例，女性5例。平均年龄(64.5±11.5)岁。经典中暑6例，劳力中暑9例。入院时格拉斯哥昏迷评分(GCS)为3～8分;入院后12小时内SOFA评分为9～17分;入院后24小时内急性生理和慢性健康评价Ⅱ(APACHEⅡ)为25～45分。治疗后,IL-6水平和SOFA评分逐渐降低,与入院相比，第二次HP后的下降有显着差异[IL-6（ng/L）：48.37（15.36，113.03）与221.90(85.87,425.90),SOFA：8.3±3.3vs.11.1±2.4,均P<0.05]。PCT水平在第一次HP后达到峰值[12.51(6.07,41.65)μg/L]，然后逐渐减少，第3次HP[1.26(0.82,5.40)μg/L后,差异有统计学意义,P<0.05]。与入院时相比，首次HP后Cr水平显着提高（μmol/L：66.94±25.57vs.110.80±31.13,P<0.01),第二次HP后Myo显着降低[μg/L：490.90（164.98，768.05）与3000.00(293.00,3000.00),P<0.05],在第三个HP之后，CK水平也显示出显着改善[U/L：476.0（413.0，922.0）与2107.0(729.0,2449.0),P<0.05]。CVVHDF联合3次HP治疗后，患者的炎症反应逐渐得到控制，器官功能逐渐恢复。在病程的第5天，WBC,PCT和IL-6水平较入院显著改善,AST,CK,LDH,Cr,Myo,CK-MB,与入院时相比，SOFA评分得到了显着校正。15例患者24小时生存率为86.67%,还有24小时,7天和28天生存率均高达73.33%。11例存活患者平均机械通气时间为(101.8±22.0)h,连续肾脏替代治疗(CRRT)时间平均为(58.8±11.0)小时,ICU平均住院时间为(6.3±1.0)天,平均总住院时间为(14.6±5.2)天。
结论：CVVHDF联合HPHA380治疗中暑MODS患者可有效改善器官功能，减轻炎性风暴。是提高重症中暑患者抢救率、降低病死率的有效手段。
方法：进行回顾性观察性研究。选取2022年7-9月湖北医药随州市中心医院重症监护病房(ICU)收治的15例中暑合并MODS患者作为研究对象。15例患者均采用CVVHDF联合HA380进行重症综合治疗。器官功能指标[包括总胆红素（TBil），天冬氨酸转氨酶（AST），肌酸激酶（CK），乳酸脱氢酶（LDH），肌酐(Cr),心肌肌钙蛋白T(cTnT),肌红蛋白(Myo),肌酸激酶同工酶（CK-MB），序贯器官衰竭评估（SOFA）]和炎症指标[包括白细胞计数（WBC），中性粒细胞计数（NEU），C反应蛋白(CRP),降钙素原(PCT),和白细胞介素-6（IL-6）]被收集。录取时上述指标的改善，在第一个HP之后，在第二个HP之后，在第三个HP之后，并在治疗第5天进行比较。结合患者的临床转归,评价CVVHDF联合HA380治疗重症热辐射疾病的综合疗效。
结果：15例患者中男性10例，女性5例。平均年龄(64.5±11.5)岁。经典中暑6例，劳力中暑9例。入院时格拉斯哥昏迷评分(GCS)为3～8分;入院后12小时内SOFA评分为9～17分;入院后24小时内急性生理和慢性健康评价Ⅱ(APACHEⅡ)为25～45分。治疗后,IL-6水平和SOFA评分逐渐降低,与入院相比，第二次HP后的下降有显着差异[IL-6（ng/L）：48.37（15.36，113.03）与221.90(85.87,425.90),SOFA：8.3±3.3vs.11.1±2.4,均P<0.05]。PCT水平在第一次HP后达到峰值[12.51(6.07,41.65)μg/L]，然后逐渐减少，第3次HP[1.26(0.82,5.40)μg/L后,差异有统计学意义,P<0.05]。与入院时相比，首次HP后Cr水平显着提高（μmol/L：66.94±25.57vs.110.80±31.13,P<0.01),第二次HP后Myo显着降低[μg/L：490.90（164.98，768.05）与3000.00(293.00,3000.00),P<0.05],在第三个HP之后，CK水平也显示出显着改善[U/L：476.0（413.0，922.0）与2107.0(729.0,2449.0),P<0.05]。CVVHDF联合3次HP治疗后，患者的炎症反应逐渐得到控制，器官功能逐渐恢复。在病程的第5天，WBC,PCT和IL-6水平较入院显著改善,AST,CK,LDH,Cr,Myo,CK-MB,与入院时相比，SOFA评分得到了显着校正。15例患者24小时生存率为86.67%,还有24小时,7天和28天生存率均高达73.33%。11例存活患者平均机械通气时间为(101.8±22.0)h,连续肾脏替代治疗(CRRT)时间平均为(58.8±11.0)小时,ICU平均住院时间为(6.3±1.0)天,平均总住院时间为(14.6±5.2)天。
结论：CVVHDF联合HPHA380治疗中暑MODS患者可有效改善器官功能，减轻炎性风暴。是提高重症中暑患者抢救率、降低病死率的有效手段。
