Tomescu Dana, Dima Simona O, Tănăsescu Sabina, Tănase Cristiana Pistol, Năstase Anca, Popescu Mihai
Department of Anaesthesiology and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Rom J Anaesth Intensive Care. 2014 Oct;21(2):134-138.
Severe sepsis and septic shock are associated with an inflammatory cascade that is primarily responsible for multiple organ dysfunction. To date, there are no specific treatments designed to modulate and rebalance inflammatory cytokines levels. We present a case of a 50 years old man with postoperative septic shock after undergoing cephalic pancreatectomy for a pancreatic cystic tumor. The use of a haemoadsorbtion device (CytoSorb) in combination with continuous veno-venous haemofiltration was associated with a decrease in TNFα, IL-1β and IFNγ and an increase in IL-10 levels measured before and after two consecutive procedures. The effect of CytoSorb on inflammatory cytokines translated into a more stable haemodynamic profile with a stable cardiac output and normalization of systemic vascular resistance index and decreased vasopressor requirements. Further prospective large clinical trials are required in order to determine the indications for CytoSorb and to evaluate the overall outcome.
严重脓毒症和脓毒性休克与一种炎症级联反应相关，该反应是导致多器官功能障碍的主要原因。迄今为止，尚无旨在调节和重新平衡炎症细胞因子水平的特异性治疗方法。我们报告一例50岁男性患者，其因胰腺囊性肿瘤接受胰头全切除术后发生脓毒性休克。使用血液吸附装置（CytoSorb）联合持续静脉-静脉血液滤过，与连续两次治疗前后测得的肿瘤坏死因子α（TNFα）、白细胞介素-1β（IL-1β）和干扰素γ（IFNγ）水平降低以及白细胞介素-10（IL-10）水平升高相关。CytoSorb对炎症细胞因子的作用转化为更稳定的血流动力学状态，心输出量稳定，全身血管阻力指数正常化，血管升压药需求减少。需要进一步开展前瞻性大型临床试验，以确定CytoSorb的适应证并评估总体结局。
