聚砜固定化纤维柱血液灌流主要有助于治疗感染性休克时收缩外周血管。

Polymyxin B-immobilized fiber column hemoperfusion mainly helps to constrict peripheral blood vessels in treatment for septic shock.

机构信息

Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

出版信息

J Intensive Care. 2015 Mar 20;3(1):14. doi: 10.1186/s40560-015-0080-9. eCollection 2015.

DOI:10.1186/s40560-015-0080-9

PMID:25866644

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4392791/

Abstract

BACKGROUND

Polymyxin B-immobilized fiber column hemoperfusion (PMX) has been reported to be effective for patients with septic shock. It remains unclear, however, how the efficacy of PMX varies according to the characteristics and underlying conditions of the patients treated. The objective of the present study was to clarify the factors that result in clinical efficacy of PMX treatment.

METHODS

We retrospectively investigated 78 consecutive patients with severe sepsis or septic shock who underwent PMX treatment. We reviewed the demographic data, routine biochemistry, microbiological data, infection focus, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, change in mean arterial pressure (MAP), inotropic score, vasopressor dependency index, plasma levels of endotoxin and lactate, PaO2/FIO2 ratio, and survival time. We also divided the patients into two groups for comparison, namely, those whose inotropic scores improved after PMX treatment (improvement group) and those whose inotropic scores did not improve (non-improvement group).

RESULTS

The inotropic score and the vasopressor dependency index significantly decreased from 18.1 to 9.9 (p < 0.05) and from 0.27 to 0.14 (p < 0.05), respectively, after PMX treatment in the overall study population, while no significant change in the PaO2/FIO2 ratio was observed (p = 0.96). The inotropic score at pre-PMX treatment was significantly higher in the improvement group than in the non-improvement group (p < 0.01). The improvement of the PaO2/FIO2 ratio after PMX treatment was significant in the improvement group (p < 0.05).

CONCLUSIONS

The improvement group's inotropic score was higher, because of peripheral blood vessels dilatation and requirement for more catecholamines. Therefore, our study suggests that PMX treatment is particularly useful for improving hemodynamics in septic shock patients with excessively dilated peripheral blood vessels.

摘要

背景

多黏菌素 B 固定纤维柱血液灌流（PMX）已被报道对感染性休克患者有效。然而，目前尚不清楚 PMX 的疗效如何因治疗患者的特征和基础疾病而异。本研究的目的是阐明导致 PMX 治疗临床疗效的因素。

方法

我们回顾性调查了 78 例接受 PMX 治疗的严重脓毒症或感染性休克患者。我们回顾了人口统计学数据、常规生化、微生物学数据、感染焦点、急性生理学和慢性健康评估（APACHE）II 评分、序贯器官衰竭评估（SOFA）评分、平均动脉压（MAP）变化、正性肌力评分、血管加压素依赖性指数、内毒素和乳酸血浆水平、PaO2/FIO2 比值和生存时间。我们还将患者分为两组进行比较，即 PMX 治疗后正性肌力评分改善的患者（改善组）和正性肌力评分未改善的患者（未改善组）。

结果

在整个研究人群中，PMX 治疗后正性肌力评分从 18.1 降至 9.9（p<0.05），血管加压素依赖性指数从 0.27 降至 0.14（p<0.05），而 PaO2/FIO2 比值无显著变化（p=0.96）。在改善组中，PMX 治疗前的正性肌力评分明显高于未改善组（p<0.01）。在改善组中，PMX 治疗后 PaO2/FIO2 比值的改善具有统计学意义（p<0.05）。