Sakamoto Yuichiro, Mashiko Kunihiro, Obata Toru, Matsumoto Hisashi, Hara Yoshiaki, Kutsukata Noriyoshi, Yokota Hiroyuki
Department of Emergency and Critical Care Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, Japan.
Indian J Crit Care Med. 2010 Jan;14(1):35-9. doi: 10.4103/0972-5229.63032.
Septic shock remains a major cause of multiple organ failure and is associated with a high mortality rate. In 1994, direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan and has since been used for the treatment of septic shock arising from endotoxemia.
We treated 36 patients with septic shock using direct hemoperfusion with PMX. The patients were analyzed in two groups based on whether they had undergone surgery prior to DHP-PMX treatment (surgical group: surgical treatment before DHP-PMX, medical group: no surgical treatment). In surgical group, DHP-PMX was started within three hours after the surgical treatment. Various factors were measured before and after DHP-PMX.
The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27.4 +/- 8.8, and the mean sepsis-related organ failure assessment (SOFA) score was 11.8 +/- 4.9 before DHP-PMX. The SOFA score was significantly higher (P = 0.0091) and the PaO2/FiO2 ratio (P/F ratio) was significantly lower (P = 0.0037) in medical group than in surgical group prior to DHP-PMX. A chi-square test showed that the survival rate in surgical group was significantly better than in medical group (P = 0.0027). The survival rate of surgical group (84.2%) was judged to be very good because the predicated survival rate based on the APACHE II score (25.0) was only 46.5%. On the other hand, the survival rate of medical group (35.3%) was almost equal to that predicted by the APACHE II score (30.6; predicted survival rate, 27.4%).
The results of this study suggest the utility of early DHP-PMX in surgical group.
感染性休克仍然是多器官功能衰竭的主要原因，且死亡率很高。1994年，日本开发了使用多粘菌素B固定化纤维柱（PMX；日本东京东丽株式会社）的直接血液灌流技术，此后一直用于治疗内毒素血症引起的感染性休克。
我们使用PMX直接血液灌流治疗了36例感染性休克患者。根据患者在DHP-PMX治疗前是否接受过手术，将患者分为两组（手术组：DHP-PMX治疗前接受手术治疗，医疗组：未接受手术治疗）。在手术组中，DHP-PMX在手术治疗后三小时内开始。在DHP-PMX治疗前后测量各种因素。
DHP-PMX治疗前，急性生理与慢性健康状况评分系统（APACHE）II的平均评分为27.4±8.8，脓毒症相关器官功能衰竭评估（SOFA）的平均评分为11.8±4.9。在DHP-PMX治疗前，医疗组的SOFA评分显著更高（P = 0.0091），动脉血氧分压/吸入氧分数比（P/F比）显著更低（P = 0.0037）。卡方检验显示，手术组的生存率显著优于医疗组（P = ）。手术组的生存率（84.2%）被判定为非常好，因为基于APACHE II评分（25.0）预测的生存率仅为46.5%。另一方面，医疗组的生存率（35.3%）几乎与APACHE II评分预测的生存率（30.6；预测生存率，27.4%）相等。
本研究结果表明早期DHP-PMX在手术组中的实用性。 0027
