Koami Hiroyuki, Sakamoto Yuichiro, Miyasho Taku, Itami Takaharu, Tamura Jun, Ishizuka Tomohito, Kawamura Yoshio, Nakamura Kozo, Miyoshi Kenjirou, Yamashita Kazuto
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University.
J Nippon Med Sch. 2014;81(3):130-8. doi: 10.1272/jnms.81.130.
This study investigated the effects of direct hemoperfusion with polymyxin B-immobilized fibers (PMX-DHP) on respiratory impairment in endotoxemic pigs.
Thirteen anesthetized, mechanically ventilated pigs were divided into PMX-DHP (n=7) and control (n=6) groups. All pigs were hemodynamically monitored with the pulse index contour cardiac output (PiCCO) system (Pulsion Medical Systems, Munich, Germany) and infused intravenously with live Escherichia coli (LD50). In the PMX-DHP group, an arteriovenous extracorporeal circuit with a PMX column was applied for 30 to 150 minutes after endotoxin injection. We analyzed the laboratory data, arterial blood gas levels, and PiCCO variables (extravascular lung water [EVLW] and pulmonary vascular permeability index [PVPI]). Furthermore, we performed computed tomography of the chest in all pigs. The data were statistically analyzed with Student's t-test, the chi-square test, and the Mann-Whitney U-test.
With PMX-DHP endotoxemia significantly decreased and blood pressure increased 150 minutes after endotoxin injection. PiCCO revealed more cases of decreased EVLW in the PMX-DHP group. PVPI increased after endotoxin infusion in both groups. Computed tomography showed improvements in the PMX-DHP group. The survival rate was greater in the PMX-DHP group (100%) than in the control group (71%).
PMX-DHP is effective for treating respiratory impairment and contributes to the decreased mortality rate in the endotoxemic pigs.
本研究探讨多黏菌素B固定纤维直接血液灌流（PMX-DHP）对内毒素血症猪呼吸功能障碍的影响。
13只麻醉、机械通气的猪被分为PMX-DHP组（n = 7）和对照组（n = 6）。所有猪均使用脉搏指示连续心输出量（PiCCO）系统（德国慕尼黑普ulsion医疗系统公司）进行血流动力学监测，并静脉注射活的大肠杆菌（半数致死量）。在PMX-DHP组中，内毒素注射后应用带有PMX柱的动静脉体外循环30至150分钟。我们分析了实验室数据、动脉血气水平和PiCCO变量（血管外肺水[EVLW]和肺血管通透性指数[PVPI]）。此外，我们对所有猪进行了胸部计算机断层扫描。数据采用学生t检验、卡方检验和曼-惠特尼U检验进行统计学分析。
使用PMX-DHP后，内毒素血症显著降低，内毒素注射150分钟后血压升高。PiCCO显示PMX-DHP组中更多病例的EVLW降低。两组内毒素输注后PVPI均升高。计算机断层扫描显示PMX-DHP组有所改善。PMX-DHP组的生存率（100%）高于对照组（71%）。
PMX-DHP可有效治疗呼吸功能障碍，并有助于降低内毒素血症猪的死亡率。
