Novelli G, Ferretti G, Ruberto F, Morabito V, Pugliese F
Contrib Nephrol. 2010;167:91-101. doi: 10.1159/000315923. Epub 2010 Jun 1.
We evaluated the ability of the endotoxin activity (EA) assay to determine the need for early intervention for endotoxemia using polymyxin B-based hemoperfusion (PMX-DHP) on septic patients.
Twenty-four patients were enrolled. Eleven patients had a high EA level (> or = 0.6) and were treated with PMX-DHP every 24 h until the EA level was low ( < 0.4). The remaining 13 patients had EA levels < 0.60 and received standard therapy only.
Two PMX-DHP treatments were performed on 4 patients, three treatments on 6 patients and four treatments on 1 patient. After the therapy, mean arterial pressure increased (69.45 to 84.09 mm Hg; p < 0.01), heart rate decreased (Ill.73 to77.91 beats/min; p < 0.01), white blood cell count decreased (18,380 to 9,550 cells/mm(3); p < 0.01), the PMN (polymorphonuclear) percentage decreased (88.45 to 67.82%; p < 0.01) and PaO(2)/FiO(2) increased (275 to 308.09; p < 0.01). All 24 patients survived to the 28-day follow-up.
The EA assay can identify patients eligible for PMX-DHP treatment and aids its therapeutic dosing.
我们评估了内毒素活性（EA）测定法对于确定脓毒症患者是否需要使用基于多粘菌素B的血液灌流（PMX-DHP）进行内毒素血症早期干预的能力。
招募了24名患者。11名患者的EA水平较高（≥0.6），每24小时接受一次PMX-DHP治疗，直至EA水平降低（<0.4）。其余13名患者的EA水平<0.60，仅接受标准治疗。
4名患者接受了两次PMX-DHP治疗，6名患者接受了三次治疗，1名患者接受了四次治疗。治疗后，平均动脉压升高（从69.45至84.09 mmHg；p<0.01），心率降低（从111.73至77.91次/分钟；p<0.01），白细胞计数降低（从18,380至9,550个细胞/mm³；p<0.01），多形核中性粒细胞（PMN）百分比降低（从88.45至67.82%；p<0.01），氧合指数（PaO₂/FiO₂）升高（从275至308.09；p<0.01）。所有24名患者均存活至28天随访期。
EA测定法可识别适合PMX-DHP治疗的患者，并有助于确定其治疗剂量。
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