Zhang Chun, Sun Borui, Lin Ting, Wang Wenjing, Jin Yufeng, Liu Sinan, Zhang Jingyao, Wang Zheng, Liu Chang
Department of SICU, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1531-1534. doi: 10.3760/cma.j.issn.2095-4352.2019.12.019.
To evaluate the efficacy and safety of oXiris hemofilter for septic shock patients.
Clinical data of septic shock patients receiving continuous renal replacement therapy (CRRT) with oXiris hemofilter in department of surgical intensive care unit (SICU) of the First Affiliated Hospital of Xi'an Jiaotong University from March 1st, 2018 to July 20th, 2019 were retrospectively analyzed. The heart rate (HR), mean arterial pressure (MAP), oxygenation index (PaO/FiO), lactate (Lac), platelet count (PLT), serum procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP), noradrenaline (NE) dosage, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure score (SOFA) were compared before and after oXiris treatment and the prognosis were also analyzed.
Six patients with septic shock were included [5 males, the average age was (56.3±11.8) years old]. A total of 13 oXiris hemofilter sets were performed during treatment. Compared with before treatment, the HR, IL-6 and CRP levels were significantly decreased after treatment [HR (bpm): 93.8±9.7 vs. 133.5±18.3, IL-6 (ng/L): 509.2±169.6 vs. 3 739.8±618.2, CRP (mg/L): 169.1±148.3 vs. 277.8±68.7, all P < 0.05], MAP, PaO/FiO and PLT were significantly increased [MAP (mmHg, 1 mmHg = 0.133 kPa): 73.3±2.2 vs. 63.3±1.6, PaO/FiO (mmHg): 166.8±40.4 vs. 95.1±56.2, PLT (×10/L): 73.3±27.5 vs. 41.2±21.4, all P < 0.05]; meanwhile, NE dosage, APACHE II and SOFA scores were significantly decreased [NE (μg×kg×min): 0.4±0.3 vs. 1.2±0.7, APACHE II: 18.8±6.9 vs. 30.0±7.3, SOFA: 11.7±4.2 vs. 17.3±2.1, all P < 0.05]. Although Lac and PCT decreased after treatment, there was no significant difference [Lac (mmol/L): 3.5±2.1 vs. 6.1±3.2, PCT (μg/L): 37.7±48.3 vs. 85.1±32.8, both P > 0.05]. At the end, 3 of the 6 patients survived and the others were discharged again medical advice. The length of SICU stay was 3 to 23 days, with an average of (13.0±8.5) days. No adverse events occurred during the treatment.
oXiris hemofilter can effectively remove inflammatory mediators in circulation, significantly improve hemodynamic status and severity, and may be considered as a safe and reliable treatment modality for septic shock patients.
评估oXiris血液滤过器用于感染性休克患者的有效性和安全性。
回顾性分析2018年3月1日至2019年7月20日在西安交通大学第一附属医院外科重症监护病房（SICU）接受oXiris血液滤过器进行连续性肾脏替代治疗（CRRT）的感染性休克患者的临床资料。比较oXiris治疗前后的心率（HR）、平均动脉压（MAP）、氧合指数（PaO₂/FiO₂）、乳酸（Lac）、血小板计数（PLT）、血清降钙素原（PCT）、白细胞介素-6（IL-6）和C反应蛋白（CRP）、去甲肾上腺素（NE）用量、急性生理与慢性健康状况评分II（APACHE II）和序贯器官衰竭评分（SOFA），并分析预后情况。
纳入6例感染性休克患者[男性5例，平均年龄（56.3±11.8）岁]。治疗期间共使用13套oXiris血液滤过器。与治疗前比较，治疗后HR、IL-6和CRP水平显著降低[HR（次/分钟）：93.8±9.7比133.5±18.3，IL-6（ng/L）：509.2±169.6比3739.8±618.2，CRP（mg/L）：169.1±148.3比277.8±68.7，均P<0.05]，MAP、PaO₂/FiO₂和PLT显著升高[MAP（mmHg，1 mmHg = 0.133 kPa）：73.3±2.2比63.3±1.6，PaO₂/FiO₂（mmHg）：166.8±40.4比95.1±56.2，PLT（×10⁹/L）：73.3±27.5比41.2±21.4，均P<0.05]；同时，NE用量、APACHE II和SOFA评分显著降低[NE（μg·kg⁻¹·min⁻¹）：0.4±0.3比1.2±0.7，APACHE II：18.8±6.9比30.0±7.3，SOFA：11.7±4.2比17.3±2.1，均P<0.05]。虽然治疗后Lac和PCT有所下降，但差异无统计学意义[Lac（mmol/L）：3.5±2.1比6.1±3.2，PCT（μg/L）：37.7±48.3比85.1±32.8，均P>0.05]。最终，6例患者中3例存活，其余患者遵医嘱出院。SICU住院时间为3至23天，平均（13.0±8.5）天。治疗期间未发生不良事件。
oXiris血液滤过器可有效清除循环中的炎症介质，显著改善血流动力学状态和病情严重程度，可考虑作为感染性休克患者安全可靠的治疗方式。
