To observe the clinical effects of continuous renal replacement therapy (CRRT) combined with hemadsorption on myocardial inhibition in patients with septic shock.

Totally 60 patients with septic shock [cardiac index (CI) < 3.0 L·min^-1·m^-2] were selected from Department of Critical Care Medicine in Shaoxing People's Hospital between May 2016 and June 2019. They were randomly divided into a control group (n = 30) and an experimental group (n = 30). The two groups were both treated with a standardized procedure for sepsis, and the patients in the experimental group received additional treatment of CRRT combined with hemadsorption for 3 days. All selected cases were monitored by pulse-indicated continuous cardiac output to record hemodynamic indexes. The CI, central venous pressure (CVP) and extravascular lung water index (EVLWI) of these two groups were recorded on admission, the 3rd and 5th days after treatment. The daily norepinephrine dose, total daily fluid volume and acute physiology and chronic health evaluation (APACHE) Ⅱ scores were also recorded and evaluated.

The differences of CI, CVP, EVLWI, daily norepinephrine dose, total daily fluid volume and APACHEⅡ scores between the two groups were all statistically significant at different time points (F = 12.543, 10.213, 12.840, 9.765, 10.821, 19.466; all P < 0.05). The differences of these indicators between the two groups were not statistically significant on admission (all P > 0.05). The CI of these two groups both improved after treatment. The CI in the experimental group was better than that in the control group on the 3rd and 5th days [(3.0 ± 1.7) L·min^-1·m^-2 vs. (2.6 ± 1.6) L·min^-1·m^-2, (3.2 ± 1.8) L·min^-1·m^-2 vs. (2.7 ± 1.8) L·min^-1·m^-2, both P < 0.05]. The CVP values decreased in both groups, and the CVP values in the experimental group were lower than those in the control group on the 3rd and 5th days after treatment [(11.9 ± 5.9) cmH₂O vs. (13.5 ± 3.1) cmH₂O, (10.6 ± 3.7) cmH₂O vs. (12.6 ± 2.6) cmH₂O, both P < 0.05]. The EVLWI of both groups gradually fell to normal levels on the 3rd and 5th days. The EVLWI was lower in the experimental group than in the control group on the 3rd day [(9.8 ± 2.4) mL/kg vs. (11.4 ± 3.3) mL/kg, P < 0.05]. The daily norepinephrine dose [(11.4 ± 3.4) mg vs. (18.9 ± 5.3) mg, (7.5 ± 2.1) mg vs. (13.2 ± 3.2) mg, both P < 0.05] and total daily fluid volume [(2 954 ± 537) mL vs. (3 624 ± 453) mL, (2 446 ± 484) mL vs. (3 243 ± 675) mL, both P < 0.05] of the experimental group were less than those of the control group on the 3rd and 5th days. The APACHEⅡ scores decreased in both groups after treatment. The APACHEⅡ scores in the experimental group were lower than those in the control group on the 3rd and 5th days[(13 ± 4) vs. (18 ± 4), (11 ± 3) vs. (13 ± 4), both P < 0.05].

CRRT combined with hemadsorption therapy can significantly improve myocardial inhibition in patients with septic shock, and improve their prognosis.