Federal State Budget Institution «Bakulev National Scientific and Practical Centre for Cardiovascular Surgery» of the Ministry of Healthcare of the Russian Federation (Bakulev NSPCCS), Moscow, Russian Federation.
Shock. 2018 Jun;49(6):658-666. doi: 10.1097/SHK.0000000000001016.
Sepsis remains the leading cause of morbidity and mortality in intensive care units. The extracorporeal therapy in the complex treatment of sepsis seems to be the most promising direction. The aim of this study was to assess the safety and effectiveness of selective endotoxin adsorption on the basis of the analysis of our own experience with the intensive therapy for sepsis in adult cardiac surgical patients. Our single-center study included 143 patients with sepsis. One hundred and three adult patients received lipopolysaccharide adsorption procedures using Toraymyxin-PMX-20R columns. The historical control group included 30 adult patients received only conservative therapy, and 10 children (6.2-14 kg) received hemoperfusion with Toraymyxin-PMX-0.5R. After the lipopolysaccharide-adsorption course, we noted improving of the hemodynamic and respiratory parameters. A favorable effect of hemoperfusion was a decrease procalcitonin and endotoxin activity assay, expressed by changes of leukocytosis, a normalization of body temperature. The 28-day survival was 53% in the study group and 30% in the control group (P = 0.037). The 28-day survival of children who received selective hemoperfusion was 90%. Our own experience with the use of selective hemoperfusion in a fairly large group of cardiovascular patients with sepsis showed the safety and efficacy of these procedures.
脓毒症仍然是重症监护病房发病率和死亡率的主要原因。在脓毒症的复杂治疗中，体外治疗似乎是最有前途的方向。本研究旨在基于我们在成人心脏外科患者脓毒症强化治疗方面的经验分析，评估选择性内毒素吸附的安全性和有效性。
我们的单中心研究包括 143 例脓毒症患者。103 例成年患者接受了 Toraymyxin-PMX-20R 柱的脂多糖吸附治疗。历史对照组包括 30 例仅接受保守治疗的成年患者，以及 10 例接受 Toraymyxin-PMX-0.5R 血液灌流的儿童（6.2-14kg）。在进行脂多糖吸附治疗后，我们注意到血流动力学和呼吸参数得到了改善。血液灌流的有利影响是降钙素原和内毒素活性测定的降低，表现为白细胞增多症的变化，体温正常化。研究组的 28 天存活率为 53%，对照组为 30%（P=0.037）。接受选择性血液灌流的儿童的 28 天存活率为 90%。我们在相当大的一组心血管患者中使用选择性血液灌流的经验表明，这些治疗方法是安全有效的。
