Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan.
Am J Emerg Med. 2013 May;31(5):893.e1-3. doi: 10.1016/j.ajem.2012.12.042. Epub 2013 Feb 8.
Septic patients often have low cardiac output. Some of them present severe cardiac dysfunction such as septic cardiomyopathy. However, no well-known and effective treatment for septic cardiomyopathy exists. The effect of endotoxin adsorption by polymyxin B–immobilized fiber column–direct hemoperfusion (PMX-DHP) and intraaortic balloon pumping (IABP) for septic shock remains uncertain. We experienced 2 very contrastive case reports of severe septic cardiomyopathy. We experienced 2 cases of severe septic cardiomyopathy with refractory shock. Case 1 with colon perforation presented refractory shock 6 hours after PMX-DHP, and IABP immediately improved her hemodynamics. In contrast, IABP had no effect at all in case 2 with viral enteritis, but PMXDHP improved her blood pressure and stroke volume markedly. The probability of impaired coronary microcirculation and relative bradycardia is the least required conditions for IABP use in severe septic cardiomyopathy. Meanwhile, PMX-DHP could be a good option for septic cardiomyopathy because of its fewer complications.
脓毒症患者常伴有心输出量降低。部分患者可出现严重心功能障碍，如感染性心肌病。然而，目前尚缺乏针对感染性心肌病的有效治疗方法。多黏菌素 B 免疫吸附纤维柱直接血液灌流（PMX-DHP）和主动脉内球囊反搏（IABP）治疗感染性休克的效果仍存在争议。我们报告了 2 例严重感染性心肌病的对比显著的病例。我们报告了 2 例严重感染性心肌病合并难治性休克的病例。第 1 例为结肠穿孔患者，在 PMX-DHP 治疗 6 小时后出现难治性休克，IABP 立即改善了她的血流动力学。相比之下，第 2 例病毒性肠炎患者对 IABP 无反应，但 PMX-DHP 明显改善了她的血压和每搏量。存在冠状动脉微循环障碍和相对心动过缓的可能性是 IABP 治疗严重感染性心肌病的最低要求条件。同时，PMX-DHP 也可能是感染性心肌病的一个不错选择，因为它的并发症较少。
