Wratten M L
Sorin Group, Acute Therapies, Mirandola, MO, Italy.
Eur J Anaesthesiol Suppl. 2008;42:1-7. doi: 10.1017/S0265021507003444.
Treatment of severe sepsis and septic shock often focuses on resolving immediate life-threatening problems related to infection (source control, antibiotics) and providing circulatory, ventilatory and other organ support. Neurologic complications, such as sepsis-associated encephalopathy, frequently occur in septic patients and are associated with higher mortality and long-term complications. As case fatalities and overall mortality continue to decline, long-term cognitive problems are becoming more common among survivors. Although the aetiology of septic encephalopathy has not been clearly established, systemic inflammation appears to play a key role in altering both the blood-brain barrier permeability and amplifying the inflammatory response. Several new therapies are now aimed at reducing systemic inflammation. These may eventually play a role in reducing neurologic complications related to the acute pathophysiology of sepsis and may be able to reduce early cerebral dysfunction with the goal of reducing long-term neurologic complications. Coupled plasma filtration adsorption is an extracorporeal therapy aimed at the non-specific removal of cytokines and mediators involved in systemic inflammation and immune suppression by the use of plasma filtration coupled to an adsorbent resin cartridge with high affinity for many cytokines and mediators. Several cytokines that are removed by coupled plasma filtration adsorption have also been implicated in blood-brain barrier permeability, leucocyte recruitment and amplification of the inflammatory response. Current studies are ongoing to determine whether treatments such as coupled plasma filtration adsorption may also be beneficial in reducing long-term neurologic complications.
严重脓毒症和脓毒性休克的治疗通常侧重于解决与感染相关的直接危及生命的问题（源头控制、抗生素治疗），并提供循环、通气及其他器官支持。神经系统并发症，如脓毒症相关性脑病，在脓毒症患者中经常出现，且与较高的死亡率和长期并发症相关。随着病例死亡率和总体死亡率持续下降，长期认知问题在幸存者中变得越来越普遍。尽管脓毒症性脑病的病因尚未明确，但全身炎症似乎在改变血脑屏障通透性和放大炎症反应中起关键作用。目前有几种新疗法旨在减轻全身炎症。这些疗法最终可能在减少与脓毒症急性病理生理学相关的神经系统并发症方面发挥作用，并可能能够减少早期脑功能障碍，以降低长期神经系统并发症的发生风险。配对血浆滤过吸附是一种体外治疗方法，旨在通过将血浆滤过与对多种细胞因子和介质具有高亲和力的吸附树脂柱相结合，非特异性去除参与全身炎症和免疫抑制的细胞因子和介质。通过配对血浆滤过吸附去除了几种细胞因子，这些细胞因子也与血脑屏障通透性、白细胞募集和炎症反应的放大有关。目前正在进行研究，以确定配对血浆滤过吸附等治疗方法是否也有助于减少长期神经系统并发症。
