Ann Intensive Care:多黏菌素B血液灌注+血液滤过能为内毒素休克患者带来多大获益?

2019-02-21 王淳 环球医学

2018年12月,西班牙学者发表在《Ann Intensive Care》的一项病例对照研究,考察了血液滤过联合多粘菌素B血流灌注对内毒素休克患者的影响。

2018年12月,西班牙学者发表在《Ann Intensive Care》的一项病例对照研究,考察了血液滤过联合多粘菌素B血流灌注对内毒素休克患者的影响。

背景:脓毒性休克是重症患者死亡的首要原因。革兰氏阴性脓毒性休克患者中,多黏菌素B血液灌注旨在清除血浆中的内毒素。研究者在脓毒性休克合并急性肾损伤(AKI)的患者中,分析了对血液灌注的临床和生物学应答。

方法:这项在大学附属医院的重症监护室进行的前瞻性病例对照研究,纳入了脓毒性休克合并疑似革兰氏阴性菌感染伴血浆内毒素活性升高(EAA>0.6EU/ml)合并需要连续肾脏替代治疗(CRRT)的AKI成年患者。脓毒性休克发病时,一半患者连续两天进行了CRRT+ 多黏菌素B 血液灌注2h/d(血液灌注组),一半患者仅接受CRRT(对照组)。研究者在前5天期间每天测量了临床、生理学和生物学参数(EAA、C-反应蛋白、降钙素原、细胞因子)。

结果:共纳入了18名患者(男性33%,平均年龄67.5岁,平均SOFA评分11.3)。腹部感染为主(50%具有腹膜炎)。开始CRRT时,72%的患者RIFLE分类为“失败”,28%为“损伤”。组间基线特征无差异。血液灌注组比对照组的患者需要更长的机械通气(12.4 vs 9.4天,P=0.03)和CRRT(8.5 vs 6天,P=0.01)时间。两组去甲肾上腺素剂量、乳酸、降钙素原、C-反应蛋白降低。第5天时,血液灌注组的EAA显着降低(0.58 EU/mL vs对照组0.73 EU/mL,P=0.03)。组间在其他生物标志物或ICU死亡率(治疗组vs对照组:33.3% vs 44.4%,P=0.5)上无显着差异。未观察到血液灌注组的不良反应。

结论:多黏菌素B血液灌注联合CRRT,可造成内毒素水平的快速下降,但是临床、生理学或生物学参数无改善。

原始出处

Navas A, et al. Impact of hemoperfusion with polymyxin B added to hemofiltration in patients with endotoxic shock: a case-control study. Ann Intensive Care. 2018 Dec 7;8(1):121. doi: 10.1186/s13613-018-0465-8.

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