oXiris滤器在脓毒性休克治疗中的应用:来自单中心的经验  

Usage of oXiris hemofilter for septic shock patients:a single-center experience

作　　者：张春[1,2] 孙博睿[3] 林婷[1,2] 王文静[1,2] 金玉峰[1,2] 刘司南[1,2] 张靖垚[1,2] 王铮[1,2] 刘昌 Zhang Chun;Sun Borui;Lin Ting;Wang Wenjing;Jin Yufeng;Liu Sinan;Zhang Jingyao;Wang Zheng;Liu Chang(Department of SICU,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China;Department of Anesthesiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第一附属医院SICU,710061 [2]西安交通大学第一附属医院肝胆外科,710061 [3]西安交通大学第一附属医院麻醉科,710061

出　　处：《中华危重病急救医学》2019年第12期1531-1534,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81601672)。

摘　　要：目的评价oXiris滤器在脓毒性休克治疗中的效果及安全性.方法回顾性分析2018年3月1日至2019年7月20日在西安交通大学第一附属医院外科ICU(SICU)收治的应用oXiris滤器行连续性肾脏替代治疗(CRRT)的脓毒性休克患者临床资料.比较患者接受oXiris滤器治疗前后心率(HR)、平均动脉压(MAP)、氧合指数(PaO2/FiO2)、血乳酸(Lac)、血小板计数(PLT)、血清降钙素原(PCT)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)、去甲肾上腺素(NE)用量、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)以及预后情况.结果纳入6例脓毒性休克患者〔男性5例,年龄(56.3±11.8)岁〕共行oXiris治疗13次.与治疗前相比,治疗后HR、IL-6、CRP水平明显降低〔HR(次/min):93.8±9.7比133.5±18.3,IL-6(ng/L):509.2±169.6比3739.8±618.2,CRP(mg/L):169.1±148.3比277.8±68.7,均P<0.05〕,MAP、PaO2/FiO2、PLT明显升高〔MAP(mmHg,1 mmHg=0.133 kPa):73.3±2.2比63.3±1.6,PaO2/FiO2(mmHg):166.8±40.4比95.1±56.2,PLT(×109/L):73.3±27.5比41.2±21.4,均P<0.05〕,同时NE用量、APACHEⅡ和SOFA评分亦明显降低〔NE(μg·kg-1·min-1):0.4±0.3比1.2±0.7,APACHEⅡ(分):18.8±6.9比30.0±7.3,SOFA(分):11.7±4.2比17.3±2.1,均P<0.05〕;虽然治疗后Lac和PCT较治疗前明显下降,但差异无统计学意义〔Lac(mmol/L):3.5±2.1比6.1±3.2,PCT(μg/L):37.7±48.3比85.1±32.8,均P>0.05〕.最终6例患者存活3例,自动出院3例;SICU住院时间3~23 d,平均(13.0±8.5)d;治疗过程中无不良事件发生.结论在脓毒性休克患者CRRT治疗中,使用oXiris滤器能有效清除循环中炎性介质,显著改善血流动力学状态及病情程度,且安全可靠.Objective To evaluate the efficacy and safety of oXiris hemofilter for septic shock patients.Methods Clinical data of septic shock patients receiving continuous renal replacement therapy(CRRT)with oXiris hemofilter in department of surgical intensive care unit(SICU)of the First Affiliated Hospital of Xi'an Jiaotong University from March 1st,2018 to July 20th,2019 were retrospectively analyzed.The heart rate(HR),mean arterial pressure(MAP),oxygenation index(PaO2/FiO2),lactate(Lac),platelet count(PLT),serum procalcitonin(PCT),interleukin-6(IL-6)and C-reactive protein(CRP),noradrenaline(NE)dosage,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure score(SOFA)were compared before and after oXiris treatment and the prognosis were also analyzed.Results Six patients with septic shock were included[5 males,the average age was(56.3±11.8)years old].A total of 13 oXiris hemofilter sets were performed during treatment.Compared with before treatment,the HR,IL-6 and CRP levels were significantly decreased after treatment[HR(bpm):93.8±9.7 vs.133.5±18.3,IL-6(ng/L):509.2±169.6 vs.3739.8±618.2,CRP(mg/L):169.1±148.3 vs.277.8±68.7,all P<0.05],MAP,PaO2/FiO2 and PLT were significantly increased[MAP(mmHg,1 mmHg=0.133 kPa):73.3±2.2 vs.63.3±1.6,PaO2/FiO2(mmHg):166.8±40.4 vs.95.1±56.2,PLT(×109/L):73.3±27.5 vs.41.2±21.4,all P<0.05];meanwhile,NE dosage,APACHEⅡand SOFA scores were significantly decreased[NE(μg·kg-1·min-1):0.4±0.3 vs.1.2±0.7,APACHEⅡ:18.8±6.9 vs.30.0±7.3,SOFA:11.7±4.2 vs.17.3±2.1,all P<0.05].Although Lac and PCT decreased after treatment,there was no significant difference[Lac(mmol/L):3.5±2.1 vs.6.1±3.2,PCT(μg/L):37.7±48.3 vs.85.1±32.8,both P>0.05].At the end,3 of the 6 patients survived and the others were discharged again medical advice.The length of SICU stay was 3 to 23 days,with an average of(13.0±8.5)days.No adverse events occurred during the treatment.Conclusion oXiris hemofilter can effectively remove inflammatory mediators in circulation,significant

关 键 词：脓毒性休克 内毒素 血液净化 

分 类 号：R45[医药卫生—治疗学]