多黏菌素B固定纤维在严重脓毒症或脓毒性休克肝移植患者中的临床疗效。

Clinical effects of use polymyxin B fixed on fibers in liver transplant patients with severe sepsis or septic shock.

作者信息

Ruberto F, Pugliese F, D'Alio A, Martelli S, Bruno K, Marcellino V, Perrella S, Cappannoli A, Mazzarino V, Tosi A, Novelli G, Rossi M, Ginanni Corradini S, Ferretti G, Berloco P B, Pietropaoli P

机构信息

Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Universita' Degli Studi di Roma La Sapienza, Roma, Italy.

出版信息

Transplant Proc. 2007 Jul-Aug;39(6):1953-5. doi: 10.1016/j.transproceed.2007.05.064.

DOI:10.1016/j.transproceed.2007.05.064

PMID:17692664

Abstract

UNLABELLED

Polymyxin B (PMX-B) is a polycationic antibiotic, known to bind the lipid A portion of endotoxin, a cell wall component exclusively found in gram-negative bacteria (GNB). An extracorporeal hemoperfusion device (TORAYMYXIN) has been developed: PMX is covalently bound to the surface of an insoluble carrier material to inactivate endotoxin in blood without exerting toxicity on the brain or the kidney. The aim of this study was to evaluate the efficacy, safety, and clinical effects of direct hemoperfusion with an immobilized polymyxin B fiber column (DHP-PMX) among liver transplant patients with severe sepsis or septic shock.

METHODS

From June 2004 to May 2005, 10 patients (6 men and 4 women) of overall mean age of 55 years (46-65 range) underwent orthotopic liver transplantation (OLT) and developed severe sepsis or septic shock according to The Consensus Conference of American College Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria. GNB were detected in all treated patients who received conventional antibiotic therapy, vasopressor or inotropic agents, and ventilatory support. The DHP-PMX treatment was performed three times in each patient. Hemodynamic and respiratory parameters and dosages of vasopressor or inotropic drugs were assessed at baseline and after each treatment.

RESULTS

No adverse events occurred. From baseline to the third treatment the mean arterial pressure increased from 64 +/- 5 mm Hg to 89 +/- 4 mm Hg); while the dosages of dobutamine and norepinephrine were reduced: 6.4 to 1 mcg/kg/min and 1.3 to 0.001 mcg/kg per min, respectively. The PaO(2)/FiO(2) ratio increased: 214 to 291 mm Hg.

CONCLUSION

The use of DHP-PMX may be an important aid in patients with sepsis in association with conventional therapy.

摘要

未标注

多粘菌素B（PMX - B）是一种聚阳离子抗生素，已知其能结合内毒素的脂质A部分，内毒素是一种仅在革兰氏阴性菌（GNB）细胞壁中发现的成分。一种体外血液灌流装置（TORAYMYXIN）已被研发出来：PMX共价结合在不溶性载体材料表面，以灭活血液中的内毒素，同时不对大脑或肾脏产生毒性。本研究的目的是评估在患有严重脓毒症或脓毒性休克的肝移植患者中，使用固定化多粘菌素B纤维柱直接血液灌流（DHP - PMX）的疗效、安全性及临床效果。

方法

2004年6月至2005年5月，10例患者（6例男性，4例女性），总体平均年龄55岁（年龄范围46 - 65岁）接受了原位肝移植（OLT），并根据美国内科医师学会/危重病医学会（ACCP/SCCM）共识会议标准发生了严重脓毒症或脓毒性休克。所有接受治疗的患者均检测到GNB，这些患者接受了常规抗生素治疗、血管升压药或强心药以及通气支持。每位患者进行3次DHP - PMX治疗。在基线和每次治疗后评估血流动力学和呼吸参数以及血管升压药或强心药的剂量。