成分血浆分离吸附滤过在创伤后脓毒症伴多器官功能障碍救治中的应用  

Fractionated plasma separation and adsorption-continuous veno-venous hemofiltration in sepsis and multiple organ dysfunction after trauma

作　　者：董建华 王凯 葛永纯 DONG Jianhua;WANG Kai;GE Yongchun(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China;Research Institute of General Surgery,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China)

机构地区：[1]东部战区总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016 [2]东部战区总医院国家肾脏疾病临床医学研究中心全军普通外科研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2023年第2期195-200,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省自然科学基金面上项目(BK20201235);军队卫勤保障能力创新与生成专项(21WQ038);院管课题军事面上项目(YYMS2021040)。

摘　　要：52岁男性患者,从8米高台坠落致严重创伤,继发脓毒症、急性肝衰竭、急性肾损伤和创伤性凝血病,予连续性肾脏替代治疗和成分血浆分离吸附联合连续性静脉-静脉血液滤过(FPSA-CVVH)治疗,并组合Mediasorb吸附柱实现强化细胞因子清除,单次治疗后总胆红素下降率57.2%~72.3%,高迁移率族蛋白1下降率最高达69.0%,白细胞介素(IL)-1β、IL-6、IL-8、IL-10、肿瘤坏死因子α、干扰素诱导蛋白10,单核细胞趋化蛋白1和巨噬细胞炎症蛋白1β下降率可达90%以上。患者短期内脓毒症得以有效控制,肝功能恢复正常,并逐步摆脱肾脏替代治疗。A 52-year-old male suffered severe trauma from high-altitude falling.The patient developed multiple organ dysfunction(acute liver failure,acute kidney injury and trauma-induced coagulopathy)and sepsis.Continuous renal replacement therapy,fractionated plasma separation and adsorption-continuous veno-venous hemofiltration(FPSA-CVVH)combined with Mediasorb adsorption column enhanced cytokines clearance were administered;total bilirubin reduction ratios were 57.2%~72.3%.Moreover,high mobility group protein-1 reduction ratios were 69.0%,interleukin(IL)-1β、IL-6、IL-8、IL-10、tumor necrosis factor-α、interferen inducible protein-10、monocyte chemotactic protein-1、macrophage inflammatory protein-1βreduction ratios were more than 90%.Sepsis was effectively controlled,and liver function of the patient was alleviated quickly.The patient gradually got rid of renal replacement therapy.

关 键 词：血液净化 多器官功能障碍 脓毒症 胆红素 细胞因子 

分 类 号：R459.7[医药卫生—急诊医学]