Yarustovsky M B, Abramyan M V, Krotenko N P, Popov D A, Plyusch M G, Gordeev S L, Rogalskaya E A
Anesteziol Reanimatol. 2015 Sep-Oct;60(5):75-80.
Clinical and laboratory evaluation of the safety and efficacy of combined application of LPS selective adsorption (using cartridges with immobilized polymyxin B on fibers) and plasma filtration and adsorption (CPFA) in patients with severe sepsis after surgery on the heart and blood vessels.
The study involved 40 adult patients with severe sepsis after cardiac surgery. Group I included 20 patients who received the combined therapy with LPS-selective adsorption and CPFA in a single circuit. The control group 2 consisted of 20 patients who received the standard complex intensive therapy of sepsis. Inclusion criteria were clinical and laboratory indices of sepsis (FAA endotoxin activity level above 0.6; procalcitonin 2 ng/ml).
Patients in Group I had an increase in mean aerial pressure by 12% (p = 0.001), the oxygenation index of 36% (p = 0.004), leukocytosis reduction (p = 0.01) and a significant decrease in body temperature (p = 0.0001). We also registered declines of FAA endotoxin activity by 35% (p = 0.0003) and Procalcitonin by 55% (p = 0.005). Patients of the control group had no significant change in the level of white blood cells, procalcitonin, and temperature. 28-day survival rate was 65 and 35% in the 1st and 2nd groups, respectively (p = 0.11).
Combination of LPS adsorption and CPFA in a single extracorporeal circuit in the complex intensive therapy is a safe and effective treatment of severe sepsis.
对采用脂多糖（LPS）选择性吸附（使用纤维上固定化多粘菌素B的柱）与血浆滤过吸附（CPFA）联合应用于心脏和血管手术后严重脓毒症患者的安全性和有效性进行临床及实验室评估。
该研究纳入40例心脏手术后严重脓毒症成年患者。第一组包括20例接受单回路LPS选择性吸附与CPFA联合治疗的患者。第二对照组由20例接受脓毒症标准综合强化治疗的患者组成。纳入标准为脓毒症的临床和实验室指标（FAA内毒素活性水平高于0.6；降钙素原>2 ng/ml）。
第一组患者平均动脉压升高12%（p = 0.001），氧合指数升高36%（p = 0.004），白细胞增多症减轻（p = 0.01），体温显著下降（p = 0.0001）。我们还记录到FAA内毒素活性下降35%（p = 0.0003），降钙素原下降55%（p = 0.005）。对照组患者白细胞、降钙素原水平及体温无显著变化。第一组和第二组的28天生存率分别为65%和35%（p = 0.11）。
在综合强化治疗中，单体外循环回路中LPS吸附与CPFA联合应用是一种安全有效的严重脓毒症治疗方法。
