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标准肾脏替代疗法联合血液灌流治疗危重症脓毒症患者。

Standard renal replacement therapy combined with hemoadsorption in the treatment of critically ill septic patients.

机构信息

Department of Anaesthesia and Critical Care, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Bucharest, Romania.

出版信息

Ther Apher Dial. 2021 Oct;25(5):663-670. doi: 10.1111/1744-9987.13612. Epub 2021 Jan 12.

Abstract

The aim of the study was to assess clinical and paraclinical effects of hemoadsorption on organ dysfunction, severity scores, and 28-day survival in septic patients. Fifty-five septic patients admitted to a general intensive care unit of a university hospital were included in the present study. Each patient underwent three consecutive 24-hour sessions of renal replacement therapy in combination with hemoadsorption. Clinical and paraclinical variables were measured after the treatment and severity scores were calculated. The use of hemoadsorption was associated with an increase in arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P = .02), urine output (P = .01), and Glasgow Coma Score (P = .03) and a decrease in white blood cell count (P = .03), C-reactive protein (P = .01), procalcitonin (P = .01) levels, and platelet count (P = .01). The use of hemoadsorption was associated with an improvement in neurological and renal functions and a decrease in inflammatory markers. Acute respiratory distress syndrome improved significantly based on relevant improvements in one-third of the patients.

摘要

本研究旨在评估血液吸附对器官功能障碍、严重程度评分和脓毒症患者 28 天生存率的临床和临床前影响。本研究纳入了 55 名入住大学医院综合重症监护病房的脓毒症患者。每位患者均接受了三次连续 24 小时的肾脏替代治疗联合血液吸附治疗。治疗后测量了临床和临床前变量,并计算了严重程度评分。血液吸附的使用与动脉血氧分压/吸入氧分数比值(P=.02)、尿量(P=.01)和格拉斯哥昏迷评分(P=.03)的增加以及白细胞计数(P=.03)、C 反应蛋白(P=.01)、降钙素原(P=.01)水平和血小板计数(P=.01)的降低相关。血液吸附的使用与神经和肾功能的改善以及炎症标志物的减少相关。根据三分之一患者的相关改善,急性呼吸窘迫综合征显著改善。

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