Sakamoto Yuichiro, Mashiko Kunihiro, Obata Toru, Matsumoto Hisashi, Hara Yoshiaki, Kutsukata Noriyoshi, Yamamoto Yasuhiro
Department of Emergency and Critical Care Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, Japan.
ASAIO J. 2008 Jul-Aug;54(4):412-5. doi: 10.1097/MAT.0b013e31817e511b.
Recently, the existence of a relationship was reported between the severity of lung injury and the serum level of F2-isoprostane, a known oxidative stress marker. Recent reports have suggested that direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX) may improve the oxygenation in patients with acute lung injury and acute respiratory distress syndrome. Because cases of septic shock associated with respiratory diseases have poor outcomes, we selected cases of septic shock associated with respiratory disease to review the characteristics of the treatment-resistant cases. We treated 13 septic shock cases due to respiratory disease using DHP-PMX. The patients were separated into 2 groups for analysis from oxygenation effect immediately after DHP-PMX: A group (7 cases) PaO2/FiO2 ratio increased more than 20%; B group (6 cases) PaO2/FiO2 ratio did not increase more than 20%. Factors were measured before DHP-PMX. The average Acute Physiology and Chronic Health Evaluation II score was 31.2 +/- 9.4, and the average sequential organ failure assessment score was 15.1 +/- 5.3 before DHP-PMX. Four patients survived and 9 died. Only the F2-Isoprostane level was significantly high in B group (p = 0.0228). A relationship between F2-Isoplostane and rebellious cases by DHP-PMX in severe respiratory disease patients became clear.
最近，有报道称肺损伤的严重程度与血清F2-异前列腺素水平之间存在关联，F2-异前列腺素是一种已知的氧化应激标志物。最近的报告表明，使用多粘菌素B固定纤维柱直接血液灌流（DHP-PMX）可能会改善急性肺损伤和急性呼吸窘迫综合征患者的氧合。由于与呼吸系统疾病相关的感染性休克病例预后较差，我们选择了与呼吸系统疾病相关的感染性休克病例来回顾难治性病例的特征。我们使用DHP-PMX治疗了13例因呼吸系统疾病导致的感染性休克病例。根据DHP-PMX后立即的氧合效果将患者分为2组进行分析：A组（7例），PaO2/FiO2比值增加超过20%；B组（6例），PaO2/FiO2比值增加未超过20%。在DHP-PMX之前测量相关因素。DHP-PMX前急性生理与慢性健康状况评分II的平均值为31.2±9.4，序贯器官衰竭评估评分的平均值为15.1±5.3。4例患者存活，9例死亡。仅B组的F2-异前列腺素水平显著升高（p = 0.0228）。F2-异前列腺素与严重呼吸系统疾病患者中DHP-PMX难治性病例之间的关系变得清晰。
