Objective To investigate the effect of pulsed colloid infusion combined with continuous blood purification (CBP) for treatment of severe capillary leak syndrome (CLS).
Methods According to random principle,61 patients were divided into a control group(n=21),a CBP1 group(n=18) and a CBP2 group(n=22). All patients of three groups received routine treatment according to international guidelines 2008 for management of severe sepsis. The patients in the control group also received pulsed infusion colloid combined lasix. The patients in the CBP1 and CBP2 groups also received continuous veno-venous hemofiltration(CVVH) for 72 hours. The patients in the CBP1 group received concentrated colloid infusion combined lasix,and the patients in the CBP2 group received concentrated colloid infusion combined removing fluid. Blood gas analysis and Impedance Cardiography was performed before and 24,48 and 72 hours after therapy. The angiopoietin-2(Ang-2) was measured. Also the length of ICU stay,duration of mechanical ventilation,and death rate of patients in 28 days were observed.
Results Compared with the control group and the CBP1 group,the length of ICU stay(days) and duration of mechanical ventilation (days) in the CBP2 group were significantly shorter(P<0.05),and the death rate in 28 days was lower(P<0.05). The patients in the CBP2 group showed more reduction in the APACHEⅡ score compared with the CBP1 group after therapy(P<0.05). The oxygenation index in the CBP2 group respectively increased at 24,48 and 72 hours after therapy(P<0.05). Compared with the control group and the CBP1 group,the oxygenation index in the CBP2 group respectively increased at the same time(P<0.05). The thoracic fluid content (TFC) in the CBP2 group respectively decreased at 24,48 and 72 hours(P<0.05) after therapy,and decreased compared with the control group and the CBP1 group at the same time(P<0.05). The serum levels of Ang-2 in the CBP2 group respectively decreased at 24,48 and 72 hours after therapy(P<0.05),and decreased compared with the control group and the CBP1 group at the same time(P<0.05).
Conclusion Pulsed colloid infusion combined with continuous blood purification can reduce the severity of capillary leak and improves the outcome of patients with severe sepsis.
Citation：
HaoDong, WangTao, LiZhi, QiZhijiang, NingFangyu, WangXiaozhi, LvChangjun. Effect of Pulsed Colloid Infusion Combined with Continuous Blood Purification for Treatment of Severe Capillary Leak Syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(1): 58-62. doi: 10.7507/1671-6205.2014014
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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Pchiule P,Chavez JC,LaManna JC.Hypoxic regulation of angiopoietin-2 expression in endothelial cells.J Biol Chem,2004,279:12171-12180.
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Van der Heijden M,van Nieuw Amerongen GP,Koolwijk P,et al.Angiopoietin-2,permeability edema,Occurrence and severity of ALI／ARDS in septic and non-septic critically ill patients.Thorax,2008,63:903-909.
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- 1. Lee YS,Kim SY,Kwon CW,et al.Two cases of systemic capillary leak syndrome that were treated with pentastarch.Korean J Intern Med,2007,22:130-132.
- 2. 景炳文,林兆奋.关于毛细血管渗漏综合征救治中有关问题的讨论.中国危重病急救医学,2009,21:705.
- 3. Chihara R,Nakamoto H,Arima H,et al.Systemic capillary leak syndrome.Intern Med,2002,41:953-956.
- 4. Chrysochoou G,Marcus RJ,Sureshkumar KK,et al.Renal replacement therapy in the critical Sale unit.Crit Care Nurs Q,2008,31:282-290.
- 5. 王锦权,陶晓根,张翠萍,等.连续性血液净化对重症脓毒症患者内皮损伤保护作用.中华急诊医学杂志,2007,16:514-517.
- 6. 韩沙沙,孙婷,李志,等.连续性血液净化治疗对严重症脓毒症患者内皮细胞功能的影响.中国危重病急救医学,2011,23:81-84.
- 7. Aird WC.Endothelium as a therapeutic target in sepsis.Curt Drug Targets,2007,8:501-507.
- 8. Aird WC.The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome.Blood,2003,101:3765-3777.
- 9. Van der Heijden M,van Nieuw Ameron-gen GP,Chedamni S,et al.The angiopoietin-Tie2 system as a therapeutic target in sepsis and acute lung injury.Expert Opin Ther Targets,2009,13:39-53.
- 10. Parikh SM,Mammoto T,Schultz A,et al.Excess circulating angiopoietin-2 may contribute to pulmonary vascular leak in sepsis in humans.PloS Med,2006,3:e46.
- 11. Pchiule P,Chavez JC,LaManna JC.Hypoxic regulation of angiopoietin-2 expression in endothelial cells.J Biol Chem,2004,279:12171-12180.
- 12. Van der Heijden M,van Nieuw Amerongen GP,Koolwijk P,et al.Angiopoietin-2,permeability edema,Occurrence and severity of ALI／ARDS in septic and non-septic critically ill patients.Thorax,2008,63:903-909.
