Uriu Kohei, Osajima Akihiko, Hiroshige Kinya, Watanabe Hiroyuki, Aibara Keiji, Inada Yoshifumi, Segawa Kayoko, Anai Hiroshi, Takagi Ichiro, Ito Aki, Kamochi Masayuki, Kaizu Kazo
Kidney Center, First Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Kitakyusyu, Japan.
Am J Kidney Dis. 2002 May;39(5):937-47. doi: 10.1053/ajkd.2002.32767.
Direct hemoperfusion (DHP) with an adsorbent column using polymyxin B-immobilized fiber (PMX-F) has been shown to improve the state of shock in patients with septic shock. However, no evidence has been presented for a direct link between endotoxin removal by DHP with PMX-F and improvement in septic shock. We retrospectively analyzed clinical profiles of 24 patients with septic shock (16 patients, gram-negative; 8 patients, non-gram-negative septic shock) who underwent DHP with PMX-F. Patients with gram-negative septic shock were characterized by hyperdynamic circulation. DHP with PMX-F reduced blood endotoxin concentrations and ameliorated shock, with an improvement in hyperdynamic circulation in patients with gram-negative septic shock. Mean arterial pressure also was elevated after therapy in patients with non-gram-negative septic shock, but systemic hemodynamics were unaffected. Regardless of the causative microorganism, patients with endotoxemia (blood endotoxin level > 10 pg/mL) showed hyperdynamic shock, and DHP with PMX-F reduced blood endotoxin levels and ameliorated hyperdynamic circulation, whereas patients without endotoxemia showed features of shock without hyperdynamic circulation, and DHP with PMX-F ameliorated shock without affecting cardiac performance. In patients with gram-negative septic shock, blood endotoxin concentration correlated positively with cardiac output and negatively with systemic vascular resistance before DHP therapy. Reduction in blood endotoxin concentration by DHP therapy positively correlated with the reduction in cardiac output. Our findings indicate that the improvement in hyperdynamic circulation was related directly to endotoxin removal by the PMX-F column, and endotoxin has an important role in the development of hyperdynamic circulation in patients with gram-negative septic shock.
使用固定多粘菌素B的纤维（PMX-F）吸附柱进行直接血液灌流（DHP）已被证明可改善感染性休克患者的休克状态。然而，尚无证据表明使用PMX-F进行DHP清除内毒素与感染性休克的改善之间存在直接联系。我们回顾性分析了24例接受PMX-F DHP的感染性休克患者（16例革兰氏阴性菌感染；8例非革兰氏阴性菌感染性休克）的临床资料。革兰氏阴性菌感染性休克患者的特点是高动力循环。使用PMX-F进行DHP可降低血内毒素浓度并改善休克，革兰氏阴性菌感染性休克患者的高动力循环也得到改善。非革兰氏阴性菌感染性休克患者治疗后平均动脉压也升高，但全身血流动力学未受影响。无论致病微生物如何，内毒素血症患者（血内毒素水平>10 pg/mL）均表现为高动力休克，使用PMX-F进行DHP可降低血内毒素水平并改善高动力循环，而无内毒素血症的患者表现为无高动力循环的休克特征，使用PMX-F进行DHP可改善休克而不影响心脏功能。在革兰氏阴性菌感染性休克患者中，DHP治疗前血内毒素浓度与心输出量呈正相关，与全身血管阻力呈负相关。DHP治疗使血内毒素浓度降低与心输出量降低呈正相关。我们的研究结果表明，高动力循环的改善与PMX-F柱清除内毒素直接相关，内毒素在革兰氏阴性菌感染性休克患者高动力循环的发生中起重要作用。
