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脓毒症与多器官衰竭中的 Oxiris 膜。

Oxiris Membrane in Sepsis and Multiple Organ Failure.

机构信息

Department of Experimental and Clinical Medicine, Section of Internal Medicine, University of Florence, Florence, Italy.

Department of Health Sciences, Universidad Pública de Navarra, Pamplona, Spain.

出版信息

Contrib Nephrol. 2023;200:55-65. doi: 10.1159/000527355. Epub 2023 Jun 1.

Abstract

Sepsis and multiple organ failure (MOF) are characterized by multiple hemodynamic changes and imbalanced immune response of the patient. Oxiris is a highly adsorptive membrane with the ability to remove cytokines and endotoxins, as well as to perform renal replacement therapy. Here we describe the evolution from previous AN69 to the 3-in-1 Oxiris membrane, and review its characteristics and performance. In clinical practice, Oxiris showed consistent effects in mean arterial pressure recovery, a decrease in vasopressor needs, and reduction of the Sequential Organ Failure Assessment score. These results have been reproduced by several independent studies addressing both sepsis and, to a lesser extent, COVID-19 patients. In addition, more recent studies in sepsis showed improvements in MOF duration and the length of stay in the ICU, as well as some promising results regarding mortality. Finally, we review ongoing clinical trials and discuss its potential significance to clinical practice improvement and to further reinforce knowledge on the use of blood purification in sepsis and acute kidney injury.

摘要

脓毒症和多器官功能衰竭(MOF)的特点是患者存在多种血流动力学变化和免疫反应失衡。Oxiris 是一种具有高吸附能力的膜,能够清除细胞因子和内毒素,并进行肾脏替代治疗。在这里,我们描述了从之前的 AN69 到 3-in-1 Oxiris 膜的演变过程,并回顾了其特点和性能。在临床实践中,Oxiris 在平均动脉压恢复、减少血管加压药需求和降低序贯器官衰竭评估评分方面显示出一致的效果。这些结果已经被几项独立的研究复制,这些研究涉及脓毒症患者,以及在较小程度上涉及 COVID-19 患者。此外,最近关于脓毒症的研究显示,MOF 持续时间和 ICU 住院时间得到改善,并且在死亡率方面有一些有希望的结果。最后,我们回顾了正在进行的临床试验,并讨论了其对改善临床实践和进一步加强脓毒症和急性肾损伤中血液净化应用知识的潜在意义。

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