Direct Hemoperfusion with Polymyxin B Immobilized Fiber (PMX) in Acute Lung Injury Induced by Endotoxemia in Anesthetized Sheep

(1)在麻醉绵羊肺淋巴瘘模型上，应用多粘菌素B固定化纤维直接血液灌流治疗(10μg/kg)急性肺损伤(ALI)。内毒素血症早期出现休克(全身血压下降)、肺动脉高压、循环白细胞减少和低氧血症，晚期肺淋巴流量增加，提示通透性水肿。PMX直接血液灌流(60ml/小时)能明显改善内毒素血症所致的休克和低氧血症，但不改变白细胞减少、肺高压和肺淋巴动力学的时程。(2)我们尝试用PMX直接血液灌流治疗ALI合并急性呼吸窘迫综合征(ARDS)8例。治疗2次后，体收缩压(由105±8 mm Hg降至137±5 mm Hg)、舒张压(由63±10 mm Hg升至78±7 mm Hg)、PaO2/FiO2(P/F值)(由130±20增至170±15)均有明显改善。

We have performed the following 2 projects under the grant.(1) In anesthetized sheep with lung lymph fistula and systemic and pulmonary hemodynamic monitoring, we evaluated the effect of direct hemoperfusion with Polymyxin B immobilized fiber (PMX) in acute lung injury (ALI) induced by E. coli endotoxemia (10 μg/kg). Endotoxemia produced shock (decreased systemic blood pressure), pulmonary hypertension, circulating leukopenia and hypoxemia during the early phase after endotoxcmia and the increases in lung lymph flow, suggesting permeability edema, during the late phase. Direct hemoperfusion (60ml/hr) with PMX significantly improved the shock and hypoxemia induced by endotoxemia, though it did not changes the time course of leukopenia, pulmonary hypertension and lung lymph dynamics.(2) We tried to treat 8 patients with ALI and acute respiratory distress syndrome (ARDS) using direct hemoperfusion with PMX. After 2 times of the treatment, systolic systemic pressure (from 105 ± 8 mmHg to 137 ± 5), diastolic pressure (from 63 ± 10 mmHg to 78 ± 7 mmHg) and PaO2/FiO2 (P/F ratio) (from 130 ± 20 to 170 ± 15) were significantly improved.