Formica Marco, Inguaggiato Paola, Bainotti Serena, Wratten Mary Lou
Nephrology and Dialysis Unit, S. Croce and Carle Hospital, Cuneo, Italy.
Contrib Nephrol. 2007;156:405-10. doi: 10.1159/000102131.
Sepsis is one of the main causes of death in critically ill patients worldwide, and in many cases it is associated with renal and/or other organ failure. However, we do not have a unique efficient therapy to reduce this extremely high mortality rate. In the last years interest around the use of extracorporeal blood purification techniques has increased. One of the emerging treatments in patients with severe sepsis and septic shock is coupled plasma filtration adsorption (CPFA), a novel extracorporeal blood purification therapy aimed at a nonselective reduction of the circulating levels and activities of both pro- and anti-inflammatory mediators. Early experimental studies and the following clinical trials have demonstrated impressive results regarding hemodynamics and respiratory parameters, even in patients without concomitant acute renal injury, paralleled by a quick tapering of vasoactive drugs. Considering the still high morbidity and mortality rates in septic shock patients, this new blood purification technique seems to have benefits when applied early in the course of sepsis, also without renal indications, suggesting that it might be performed to prevent rather than to treat acute kidney injury.
脓毒症是全球危重症患者主要的死亡原因之一，在许多情况下，它与肾脏和/或其他器官衰竭相关。然而，我们并没有一种独特有效的疗法来降低这种极高的死亡率。在过去几年中，人们对体外血液净化技术的应用兴趣有所增加。在严重脓毒症和脓毒性休克患者中新兴的治疗方法之一是配对血浆滤过吸附（CPFA），这是一种新型的体外血液净化疗法，旨在非选择性地降低循环中促炎和抗炎介质的水平及活性。早期的实验研究以及随后的临床试验表明，即使在没有合并急性肾损伤的患者中，该疗法在血流动力学和呼吸参数方面也取得了令人瞩目的结果，同时血管活性药物的用量迅速减少。鉴于脓毒性休克患者的发病率和死亡率仍然很高，这种新的血液净化技术在脓毒症病程早期应用时似乎具有益处，即使没有肾脏方面的指征，这表明它可能是用于预防而非治疗急性肾损伤。
