Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation.
Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation.
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DOI：
10.1186/cc3815
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Tanjoh K
中科院分区：
文献类型：
--
作者：
Kushi H;Miki T;Okamaoto K;Nakahara J;Saito T;Tanjoh K
本研究旨在探讨固定化多粘菌素B纤维柱（DHP-PMX）直接血液灌流治疗脓毒症所致急性肺损伤或急性呼吸窘迫综合征的疗效及作用机制。纳入36例脓毒症患者。每例患者均插入热稀释导管，测量氧输送指数和耗氧量指数。对氧输送指数和耗氧量指数正常（> 500 ml/min / m2, >120 ml/min / m2）的患者进行DHP-PMX。急性生理和慢性健康评估II评分作为脓毒症严重程度的指标，并在1个月后评估生存。测量的体液介质为趋化因子IL-8、纤溶酶原激活物抑制剂-1和中性粒细胞弹性酶（NE）。在DHP-PMX治疗前以及治疗开始后24、48和78小时测量这些介质。在DHP-PMX治疗前和治疗开始后24、48、72、92和120小时测量动脉氧张力(PaO2)/分数吸入氧（FiO2）比。所有患者在1个月后仍然存活。DHP-PMX治疗前，急性生理与慢性健康评估II评分为24±2.0，IL-8水平为54±15.8 pg/ml，纤溶酶原激活物抑制剂-1水平为133±28.1 ng/ml， NE水平为418±72.1 μg/l。这三种体液介质在DHP-PMX处理后24小时开始下降，并在48小时后下降明显。DHP-PMX治疗前PaO2/FiO2比值为244±26.3,96 h后明显改善。PaO2/FiO2比值与血NE、IL-8水平呈显著负相关。DHP-PMX的作用机制尚不完全清楚，但我们报告了以下发现。血浆纤溶酶原激活物抑制剂-1、NE和IL-8的平均水平在DHP-PMX治疗后48小时显著降低。DHP-PMX处理96小时后，PaO2/FiO2比值显著提高。PaO2/FiO2比值的改善似乎与血液NE和IL-8水平的降低有关。
The objective of this study was to clarify the efficacy and mechanism of action of direct hemoperfusion with an immobilized polymyxin B fiber column (DHP-PMX) in patients with acute lung injury or acute respiratory distress syndrome caused by sepsis. Thirty-six patients with sepsis were included. In each patient a thermodilution catheter was inserted, and the oxygen delivery index and oxygen consumption index were measured. DHP-PMX was performed in patients with a normal oxygen delivery index and oxygen consumption index (> 500 ml/minute per m2 and >120 ml/minute per m2, respectively). The Acute Physiology and Chronic Health Evaluation II score was used as an index of the severity of sepsis, and survival was assessed after 1 month. The humoral mediators measured were the chemokine IL-8, plasminogen activator inhibitor-1, and neutrophil elastase (NE). These mediators were measured before DHP-PMX treatment, and at 24, 48, and 78 hours after the start of treatment. The arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was measured before DHP-PMX treatment and at 24, 48, 72, 92, and 120 hours after the start of treatment. All patients remained alive after 1 month. Before DHP-PMX treatment, the Acute Physiology and Chronic Health Evaluation II score was 24 ± 2.0, the IL-8 level was 54 ± 15.8 pg/ml, plasminogen activator inhibitor-1 was 133 ± 28.1 ng/ml, and NE was 418 ± 72.1 μg/l. These three humoral mediators began to decrease from 24 hours after DHP-PMX treatment, and the decline became significant from 48 hours onward. The PaO2/FiO2 ratio was 244 ± 26.3 before DHP-PMX treatment but improved significantly from 96 hours onward. There were significant negative correlations between the PaO2/FiO2 ratio and blood levels of NE and IL-8. The mechanism of action of DHP-PMX is still not fully understood, but we report the following findings. The mean blood levels of plasminogen activator inhibitor-1, NE, and IL-8 were significantly decreased from 48 hours after DHP-PMX treatment. The mean PaO2/FiO2 ratio was significantly improved from 96 hours after DHP-PMX treatment. Improvement in the PaO2/FiO2 ratio appeared to be related to the decreases in blood NE and IL-8 levels.
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影响因子：
4.2
作者：
Jaber, BL;Barrett, TW;Pereira, BJG
通讯作者：
Pereira, BJG
影响因子：
15.3
作者：
VANDAMME, J;VANBEEUMEN, J;BILLIAU, A
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BILLIAU, A
影响因子：
3
作者：
Nemoto, H;Nakamoto, H;Suzuki, H
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Suzuki, H
影响因子：
3.1
作者：
Vincent, JL;Laterre, PF;John, S
通讯作者：
John, S
影响因子：
17.3
作者：
QUEZADO, ZMN;BANKS, SM;NATANSON, C
通讯作者：
NATANSON, C