Department of Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan.
Surg Today. 2013 Sep;43(9):1031-8. doi: 10.1007/s00595-012-0399-y. Epub 2012 Nov 6.
Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been reported to improve the outcomes in patients with colorectal perforation. We retrospectively identified prognostic factors in patients with colorectal perforation and considered the efficacy of PMX-DHP based on these prognostic factors.
One hundred and fifty-six patients who underwent surgery for colorectal perforation in our department between November 1995 and March 2011 were enrolled in this study. The clinicopathological factors were compared between the survivor and non-survivor groups.
There were 28 patients (17.9 %) who died within 28 days after surgery. According to the multivariate analysis, an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 17 or more was a significant independent prognostic factor (P = 0.002, odds ratio = 5.39). There was a significant difference in the survival rates between the patients with APACHE II scores of 16 or less and those with scores of 17 or more who had received the PMX-DHP (+) (P < 0.0001).
The APACHE II score is useful as a prognostic factor in patients with colorectal perforation, and the survival rate was 50 % or lower among the patients with APACHE II scores of 17 or higher. Therefore, PMX-DHP appears to have limited efficacy in serious cases.
已有报道称，使用聚砜固定化多粘菌素 B 纤维（PMX-DHP）直接血液灌流可改善大肠穿孔患者的预后。我们回顾性地确定了大肠穿孔患者的预后因素，并根据这些预后因素考虑了 PMX-DHP 的疗效。
本研究纳入了 1995 年 11 月至 2011 年 3 月期间在我院接受大肠穿孔手术的 156 例患者。对存活组和死亡组患者的临床病理因素进行了比较。
术后 28 天内有 28 例（17.9%）患者死亡。多因素分析显示，急性生理学与慢性健康状况评分系统 II（APACHE II）评分≥17 是一个显著的独立预后因素（P=0.002，优势比=5.39）。APACHE II 评分在 16 分及以下的患者和评分在 17 分及以上的患者中，PMX-DHP 治疗组的生存率存在显著差异（P＜0.0001）。
APACHE II 评分可作为大肠穿孔患者的预后因素，APACHE II 评分≥17 的患者的生存率为 50%或更低。因此，PMX-DHP 在严重情况下的疗效有限。
