Effect of ultrasound-guided blood purification on endothelial and coagulation function in traumatic sepsis patients
Objective To investigate the effect of continuous bedside blood purification guided by pulmo-nary ultrasound and inferior vena cava(IVC)on vascular endothelium and coagulation function in patients with post-traumatic sepsis complicated by acute renal functional injury.Methods A total of 116 patients with post-trau-matic sepsis complicated by acute renal functional injury and treated by continuous blood purification in 5 hospitals(author affiliations)from Jan.2020 to Nov.2022 were prospectively included.There were 84 males and 32 females aged 23-68(mean 46.8)years.The ISS was 35.36±6.48 on average.There were 75 cases of road traffic injuries,20 falls from height,16 heavy object impact/crushing injuries,and 5 others.Patients were randomly divided into ex-perimental group and control group by random numbers,with 58 cases in each group.For the experimental group,HR,MAP,pulmonary ultrasound B-line score,IVC diameter,and IVC respiratory variation index were jointly used to guide the hourly water removal by bedside continuous blood purification:(1)the volume was controlled based on MAP＞65 mmHg;(2)the goal was defined as IVC diameter ≤2.1 cm and respiratory variation rate ≤ 50％or IVC diameter＞2.1 cm and respiratory variation rate＞50％;and(3)the lung ultrasound B-line score ≤5.For the control group,only routine maintenance of MAP＞65 mmHg was required.The effects of blood purification treatment on vascular pseudophilia factor(vWF),APTT,D-dimer(D-D),WBC,platelet count(Plt),precalcitonin(PCT),oxygenation index(PO2/FiO2),acute physiology and chronic health status score(APACHE-Ⅱ)at 24 h after treat-ment,length of stay in ICU,volume of water removal,and 28-day survival rate were recorded and compared between the two groups.Results After continuous blood purification treatment for 24 h,the experimental group showed sig-nificantly lower values of vWF(303.13％±60.28％vs.331.19％±65.01％),APTT(s,42.00±10.86 vs.46.51±12.66,D-D(μg/mL,1.90±2.54 vs.4.03±3.41),WBC(×109/L,12.83±5.95 vs.15.68±6.27),PCT(ng/mL,2.62±0.14 vs.3.37±0.52),APACHE Ⅱ score(15.97±1.86 vs.17.03±2.07)and length of ICU stay(d,14.0±1.8 vs.15.7±2.2),and much higher Plt(×109/L,104.80±37.89 vs.90.44±29.31),PO2/FiO2(253.37±36.25 vs.222.59±39.86)and water removal volume(mL,339.69±51.15 vs.305.68±52.75,all P＜0.05 compared with the control group).Conclusion Pulmonary ultrasound+IVC as volume management indexes to guide continuous bedside blood purification in patients with post-traumatic sepsis combined with acute renal functional injury can ef-fectively improve patients'coagulation function,reduce vWF level and ICU stay,and can be applied in clinical prac-tice.
TraumaSepsisUltrasoundContinuous blood purificationCoagulation function
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