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[血液吸附在暴发性脑膜炎球菌血症感染性中毒性休克及多器官功能衰竭综合征治疗中的作用]

[Role of hemosorption in the therapy of infectious toxic shock and the multiple-organ failure syndrome in a fulminating form of meningococcemia].

作者信息

Pokrovskiĭ V I, Radzivil G G, Beloborodov V B, Broniakin Iu V, Roslyĭ I M

出版信息

Ter Arkh. 1986;58(9):117-22.

PMID:3787481
Abstract

Hemoperfusion was applied to the treatment of 20 patients with fulminant meningococcemia complicated by the infectious-toxic shock, stage III, and the polyorgan insufficiency syndrome. Ten patients recovered while the remaining 10 died mainly because of irreversible lesions of the vitally important organs: kidneys, adrenals, heart and brain. In the deceased patients, the prehospital stage had lasted two times longer than in the convalescents. All the patients had received antishock therapy: correction of acidosis, artificial ventilation of the lungs, dopamine, pharmacological doses of steroids and protease inhibitors as well as moderate infusion therapy. Hemoperfusion was instituted immediately after elimination of arterial hypotension. The use of hemoperfusion promoted the abatement of systemic toxicosis and neurotoxicosis, the recovery and stabilization of the hemodynamics, improvement of rheological properties of the blood, the recovery of effective tissue perfusion, the lowering of specific antigenemia and blood toxicity, and elimination of the pathological protein complexes from the circulating blood.

摘要

血液灌流应用于20例暴发性脑膜炎球菌血症合并感染性中毒性休克Ⅲ期及多器官功能不全综合征患者的治疗。10例患者康复,其余10例死亡,主要原因是重要器官(肾脏、肾上腺、心脏和大脑)出现不可逆病变。在死亡患者中,院前阶段持续时间比康复患者长两倍。所有患者均接受了抗休克治疗:纠正酸中毒、肺人工通气、多巴胺、药理剂量的类固醇和蛋白酶抑制剂以及适度的输液治疗。在消除动脉低血压后立即进行血液灌流。血液灌流的使用促进了全身中毒和神经中毒的减轻、血液动力学的恢复和稳定、血液流变学特性的改善、有效组织灌注的恢复、特异性抗原血症和血液毒性的降低以及循环血液中病理性蛋白复合物的清除。

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