Kim Gun Woo, Hwang Suyeong, Lim Kyoung Hoon, Cho Sung Hoon
Department of Surgery, Trauma Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
J Trauma Inj. 2024 Dec;37(4):295-299. doi: 10.20408/jti.2024.0051. Epub 2024 Dec 4.
Reperfusion injury can cause tissue damage due to ischemia, with severe cases potentially resulting in multiorgan failure. Cytokine storm, a life-threatening systemic inflammatory state characterized by elevated levels of circulating cytokines and hyperactive immune cells, can also lead to tissue damage and multiorgan failure. Reperfusion injury and cytokine storm sometimes exhibit similar clinical features, necessitating specific treatment in severe cases. A 31-year-old man sustained a stab wound to his left knee. Computed tomography angiography and surgical exploration revealed a transection of the left popliteal artery and vein. Both vessels were revascularized via end-to-end anastomosis approximately 3 hours after the injury. On postoperative day 2, marked increases were observed in levels of aspartate aminotransferase (8,600 U/L), alanine transaminase (6,690 U/L), creatine phosphokinase (26,817 U/L), and lactate dehydrogenase (7,398 U/L) levels. Elevated levels of interleukin 6 (178 pg/mL) and ferritin (41,079 ng/mL) were also noted. Given the possibility of either reperfusion injury or cytokine storm, plasmapheresis was initiated. Following two rounds of plasmapheresis, the patient's condition rapidly improved, and he was discharged without complications. Reperfusion injury can arise when a target blood vessel is revascularized, particularly during severe stages of ischemia. Cytokine storm represents a life-threatening systemic inflammatory state characterized by high levels of circulating cytokines and overactive immune cells. Both reperfusion injury and cytokine storm can cause systemic inflammation and multiorgan failure. These two conditions may exhibit similar clinical features, necessitating supportive care primarily to prevent organ dysfunction. However, plasmapheresis may represent an effective treatment option in cases of severe progression.
再灌注损伤可因缺血导致组织损伤，严重时可能导致多器官功能衰竭。细胞因子风暴是一种危及生命的全身性炎症状态，其特征为循环细胞因子水平升高和免疫细胞过度活跃，也可导致组织损伤和多器官功能衰竭。再灌注损伤和细胞因子风暴有时表现出相似的临床特征，严重时需要进行特殊治疗。一名31岁男性左膝受刺伤。计算机断层血管造影和手术探查显示左腘动脉和静脉横断。受伤后约3小时，通过端端吻合对两根血管进行了血运重建。术后第2天，观察到天冬氨酸转氨酶（8600 U/L）、丙氨酸转氨酶（6690 U/L）、肌酸磷酸激酶（26817 U/L）和乳酸脱氢酶（7398 U/L）水平显著升高。还注意到白细胞介素6（178 pg/mL）和铁蛋白（41079 ng/mL）水平升高。鉴于可能是再灌注损伤或细胞因子风暴，开始进行血浆置换。经过两轮血浆置换后，患者病情迅速好转，无并发症出院。当目标血管进行血运重建时，尤其是在缺血的严重阶段，可能会发生再灌注损伤。细胞因子风暴是一种危及生命的全身性炎症状态，其特征是循环细胞因子水平高和免疫细胞过度活跃。再灌注损伤和细胞因子风暴均可导致全身炎症和多器官功能衰竭。这两种情况可能表现出相似的临床特征，主要需要支持性护理以预防器官功能障碍。然而，在病情严重进展的情况下，血浆置换可能是一种有效的治疗选择。
