Treatment of sepsis by plasma endotoxin removal: hemoperfusion using a polymyxin-B immobilized column
Treatment of sepsis by plasma endotoxin removal: hemoperfusion using a polymyxin-B immobilized column
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DOI：
10.1177/096805199700400407
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发表时间：
1997-08-01
期刊：
影响因子：
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通讯作者：
Sugimoto, T
中科院分区：
文献类型：
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作者：
Kodama, M;Tani, T;Sugimoto, T
进行了I期临床试验，以评价使用含有化学固定化多粘菌素B纤维（PMX-F）的药筒直接血液灌流清除内毒素的效果。37例内毒素血症合并多器官功能衰竭（MOF）患者接受了治疗。使用PMX-F柱进行直接血液灌流2 h（PMX）。PMX能清除严重内毒素血症患者循环中的内毒素。血浆内毒素水平在PMX-F柱入口和出口处均显著降低（P < 0.01）。所有PMX组（n = 51）的平均血浆内毒素浓度在PMX前为83.7 ± 26.7 pg/ml，在PMX后显著降低至56.4 ± 27.9 pg/ml（P < 0.01）。PMX治疗后存活者血浆内毒素水平明显降低，而死亡者血浆内毒素水平无明显变化（P> 0.05）。PMX治疗后体温、血压、心脏指数、体循环血管阻力和耗氧指数明显改善。停用或减少PMX的正性肌力药和升压药。PMX治疗显示血浆内毒素水平的降低与脓毒症综合征（尤其是心血管损伤）的改善之间存在相关性。此外，这种新的治疗似乎影响严重脓毒症或脓毒症MOF患者的内毒素血症的结果。
A Phase I clinical trial was carried out to evaluate the effects of endotoxin elimination by direct hemoperfusion using a cartridge containing chemically immobilized polymyxin B fibers (PMX-F). Thirty-seven endotoxemic patients with multiple organ failure (MOF) were treated. Direct hemoperfusion for 2 h using a PMX-F column was performed (PMX). PMX could remove circulating endotoxin from severely endotoxemic patients. Plasma endotoxin level was significantly decreased between its inlet and outlet level of PMX-F column (P < 0.01). The mean plasma endotoxin concentration of all PMX (n = 51) was 83.7 +/- 26.7 pg/ml before PMX, and significantly decreased to 56.4 +/- 27.9 after (P < 0.01). Plasma endotoxin was significantly decreased in survivors, but that of non-survivors did not change with PMX (P < 0.05). Body temperature, blood pressure, cardiac index, systemic vascular resistance and the oxygen consumption index improved significantly after PMX. Inotropic and vasopressive drugs were discontinued or reduced with PMX. PMX treatment showed a correlation between reduction of plasma endotoxin level and the improvement of septic syndrome, especially cardiovascular impairments. Also, this new therapy seemed to influence the outcome of severe sepsis or septic MOF patients with endotoxemia.