Department of Emergency and Disaster Medicine, Juntendo University, Hongo, Bunkyo-ku, Japan.
J Surg Res. 2011 Dec;171(2):755-61. doi: 10.1016/j.jss.2010.04.058. Epub 2010 May 22.
Direct hemoperfusion with a polymyxin B-immobilized column (PMX-DHP) is recognized to be effective for the treatment of septic shock and is widely applied in Japan. However, it is still unknown whether the efficacy is limited to cardiovascular dysfunction. Therefore, the purpose of this study was to examine the effects of PMX-DHP on a non-hypotensive sepsis model.
Wistar rats were assigned to either a PMX-DHP group, control group, or sham group (n=7 in each group). A sepsis model was made by intravenous infusion of live E. coli. (LD50). The change in systemic blood pressure was less than 20% of the initial level in this model. In the PMX-DHP group, an arteriovenous extracorporeal circuit with a PMX column was applied until 3 h after E. coli injection. The same procedure with a dummy column was applied in the control group. Plasma levels of ALT, LDH, BUN, tumor necrosis factor alpha (TNFα), interleukin (IL)-1β, IL-6, and IL-10 were measured. The mesenteric microcirculation was observed at 1 and 3 h after E. coli injection. In another series, survival was calculated up to 18 h (n=14 in each group).
Organ damage markers were lower in the PMX-DHP group. The levels of pro-inflammatory cytokines were significantly lower in the PMX-DHP group than in the control group. Microcirculation was better maintained in the PMX-DHP group. Survival was significantly better in the PMX-DHP group (93%) compared with that in the control group (57%, P=0.03).
PMX-DHP was effective in a non-hypotensive sepsis model.
多粘菌素 B 固定化柱（PMX-DHP）直接血液灌流被认为对治疗感染性休克有效，并在日本广泛应用。然而，其疗效是否仅限于心血管功能障碍尚不清楚。因此，本研究旨在探讨 PMX-DHP 对非低血压性脓毒症模型的影响。
Wistar 大鼠分为 PMX-DHP 组、对照组和假手术组（每组 7 只）。通过静脉输注活大肠杆菌（LD50）建立脓毒症模型。该模型中全身血压变化低于初始水平的 20%。在 PMX-DHP 组，在大肠杆菌注射后 3 小时内应用带 PMX 柱的动静脉体外循环。对照组应用假柱进行相同的操作。测量 ALT、LDH、BUN、肿瘤坏死因子-α（TNFα）、白细胞介素（IL）-1β、IL-6 和 IL-10 的血浆水平。在大肠杆菌注射后 1 和 3 小时观察肠系膜微循环。在另一系列中，计算 18 小时内的生存率（每组 n=14）。
PMX-DHP 组的器官损伤标志物较低。PMX-DHP 组促炎细胞因子水平明显低于对照组。PMX-DHP 组的微循环得到更好的维持。PMX-DHP 组的生存率明显优于对照组（93%比 57%，P=0.03）。
PMX-DHP 对非低血压性脓毒症模型有效。
