血液灌流治疗新型冠状病毒肺炎重型及危重型患者的疗效。

Efficacy of Hemoperfusion in Severe and Critical Cases of COVID-19.

机构信息

Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

Blood Purif. 2023;52(1):8-16. doi: 10.1159/000524606. Epub 2022 May 17.

DOI:10.1159/000524606

PMID:35580567

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9393767/

Abstract

INTRODUCTION

Uncontrolled overproduction of inflammatory mediators is predominantly observed in patients with severe COVID-19. The excessive immune response gives rise to multiple organ dysfunction. Implementing extracorporeal therapies may be useful in omitting inflammatory mediators and supporting different organ systems. We aimed to investigate the effectiveness of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients.

METHOD

We conducted a single-center, matched control retrospective study on patients with confirmed SARS-CoV-2 infection. Patients were treated with hemoperfusion in combination with standard therapy (hemoperfusion group) or standard treatment (matched group). Hemoperfusion or hemoperfusion and continuous renal replacement therapies were initiated in the hemoperfusion group. The patients in the matched group were matched one by one with the hemoperfusion group for age, sex, oxygen saturation (SPO2) at the admission, and the frequency of using invasive mechanical ventilation during hospitalization. Two types of hemoperfusion cartridges used in this study were Jafron© (HA330) and CytoSorb® 300.

RESULT

A total of 128 COVID-19-confirmed patients were enrolled in this study; 73 patients were allotted to the matched group and 55 patients received hemoperfusion. The median SPO2 at the admission day in the control and hemoperfusion groups was 80% and 75%, respectively (p value = 0.113). The mortality rate was significantly lower in the hemoperfusion group compared to the matched group (67.3% vs. 89%; p value = 0.002). The median length of ICU stay was statistically different in studied groups (median, 12 days for hemoperfusion group vs. 8 days for the matched group; p < 0.001). The median final SPO2 was statistically higher in the hemoperfusion group than in the matched group, and the median PaCO2 was lower.

CONCLUSION

Among critically ill COVID-19 patients, based on our study, the use of hemoperfusion may reduce the mortality rate and improve SPO2 and PaCO2.

摘要

简介

在重症 COVID-19 患者中，主要观察到炎症介质的失控性过度产生。过度的免疫反应导致多器官功能障碍。实施体外治疗可能有助于去除炎症介质并支持不同的器官系统。我们旨在研究血液灌流联合标准治疗在重症 COVID-19 患者中的疗效。

方法

我们对确诊为 SARS-CoV-2 感染的患者进行了一项单中心、匹配对照回顾性研究。患者接受血液灌流联合标准治疗（血液灌流组）或标准治疗（匹配组）。血液灌流组开始进行血液灌流或血液灌流联合连续肾脏替代治疗。匹配组的患者与血液灌流组一一匹配，匹配因素包括年龄、入院时的血氧饱和度（SPO2）和住院期间使用有创机械通气的频率。本研究中使用的两种血液灌流试剂盒是 Jafron©（HA330）和 CytoSorb® 300。

结果

本研究共纳入 128 例 COVID-19 确诊患者；73 例患者分配至匹配组，55 例患者接受血液灌流。对照组和血液灌流组入院当天的 SPO2 中位数分别为 80%和 75%（p 值=0.113）。与匹配组相比，血液灌流组的死亡率显著降低（67.3%比 89%；p 值=0.002）。两组患者的 ICU 住院时间中位数存在统计学差异（血液灌流组为 12 天，匹配组为 8 天；p<0.001）。血液灌流组的终末 SPO2 中位数显著高于匹配组，PaCO2 中位数较低。