探讨血液灌流（HP）对急性药物中毒患者血中毒物的清除作用及临床疗效。方法：收集我院2002年7月～2006年12月住院的鼠药（主要为毒鼠强、四亚甲基二砜四胺）和部分药物中毒患者69例，其中34例按常规给予洗胃、解毒、排毒、保肝、利尿或呼吸支持等综合治疗（非HP组），35例在综合治疗基础上同时给予HP。通过观察灌流前后的临床疗效。结果：HP组35例中死亡3例，生存率91.4%，非HP组34例中死亡5例，生存率85.3%（P＞0.05）。HP组病程明显缩短（P＜0.05）。HP后患者意识清醒及抽摔停止时间较非HP组显著提前。通过对清除率的计算发现：不同药物的清除效果有差异，其中氮卓类清除效果好，清除率为（91.6±12.5）%。结论：HP能不同程度清除体内毒物，可明显缩短病程、减少并发症，对于急性重度中毒可望提高生存率。
We established acute cholangitis and endotoxiemia in 18 rabbits by ligating the common bile duct and injecting E coli(O111B4 strain)into the common bile duct. After perfusion through activated charcoal via femoral artery-vein pathway, the average blood levels of endotoxin decreased sighificantly from 2.24Eu/ml to 0.17Eu/ml(Plt;0.001). This result suggested that blood perfusion through activated charcoal may be a promising therapy for acute endotoxemia.
目的 观察三种不同血液净化方式[血液透析（HD）、血液透析滤过（HDF）、血液透析+血液灌流（HD+HP）]对维持性血液透析患者高磷血症清除效果。 方法 选择2009年2月－2011年2月行维持性血液透析的48例高磷血症患者为研究对象，所有患者在低钙透析（1.25 mmol/L）的基础，随机分为HD组、HDF组、HD+HP组，每组16例，分别在治疗时及治疗后4周、8周检查钙、磷、钙磷乘积和全段甲状旁腺激素，并观察其变化。 结果 在治疗4周、8周后，HDF组、HD+HP组磷较前均显著下降（P值均＜0.05），两组同时点相比较差异无统计学意义（P＞0.05）；HD组较前血磷无明显变化（P＞0.05）。 结论 HDF、HP清除维持性血液透析患者高磷有显著的效果，而HD效果则不佳。
目的 通过比较三种血液净化方式对炎症介质、甲状旁腺激素等中大分子毒素的清除效果，并观察促红细胞生成素（EPO）的治疗效果，探寻有利于肾性贫血改善的最佳透析模式。 方法 2011年5月－8月采用前瞻性、随机对照、开放式设计，选择维持性血透患者60例，随机分成3组，每组20例。血液灌流（HDP）组[每2周5次血液透析（HD）+1次HDP]、血液透析滤过治疗（HDF）组（每2周5次HD+1次HDF）、HD组（每2周6次HD），随访3个月。检测试验前后反应蛋白（CRP）、β2微球蛋白、甲状旁腺素（PTH）、白介素-6的水平以及各组患者肾性贫血指标的变化。 结果 3个月试验结束时，HDP组和HDF组4项尿毒症毒素水平均显著下降，其中HDP组CRP水平明显低于HDF组（P＜0.05）；HDP组和HDF组试验后的血红蛋白水平较试验前升高，ERI值下降。HD组试验前后的毒素水平无明显变化，ERI值升高。3组患者均未出现严重不良事件。 结论 HDP和HDF清除中大分子毒素的能力优于HD，有利于缓解微炎症状态，改善EPO治疗效果。HDP和HDF的远期效果哪种更好，尚有待于进一步的研究。
目的:总结急性重症中毒并急性肾功能衰竭(ARF)的临床特点并探讨多种血液净化(BP)模式抢救急性重症中毒的临床疗效。方法:回顾性分析我院30例急性中毒并ARF患者,其中9例行血液透析(HD)治疗,11例行HD串联血液灌流(HD＋HP)治疗,10例采用连续性静脉-静脉血液透析滤过(CVVHDF)治疗,各组均给予综合性治疗,比较单纯HD组、HD＋HP组、CVVHDF组之间治疗效果。结果:CVVHDF组治愈率高,肾功能恢复优于其他血液净化组(P﹤0.05),昏迷者的清醒时间快,住院时间缩短(P﹤0.05),无明显毒副作用。结论:CVVHDF、HD＋HP血液净化治疗抢救各种急性中毒并ARF患者成功率高,对急性重症中毒伴多器官功能障碍者,提倡早期行CVVHDF治疗,同时重视洗胃、营养支持、水电解质酸碱平衡、抗感染等综合治疗,以利于急危重症中毒患者的救治。
Objective To study the clinical protective effect of hemoperfusion combined with hemofiltration on inflammatory reaction of hyperlipidemia severe acute pancreatitis (HLSAP). Methods Thirty-seven patients with HLSAP treated between January 2012 and December 2014 were selected and divided into three groups based on different treatments. Thirteen patients were allocated into hemoperfusion combined with continuous veno-venous hemofiltration group (HP+CVVH group) and treated with hemoperfusion combined with hemofiltration; 11 patients were allocated into continuous veno-venous hemofiltration group (CVVH group) and treated with hemofiltration; and all the other patients were allocated into control group and treated with conventional treatment. The levels of blood triglyceride, C-reactive protein, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) and acute physiology and chronic health evaluation (APACHE)Ⅱ score of the patients after treatment were observed. The hospital stay, organ dysfunction rate and mortality of the patients were measured. Results Compared with the control group, the levels of blood triglyceride, C-reactive protein, TNF-α, IL-6, IL-8 and APACHE Ⅱ score of the patients in the HP+CVVH group and CVVH group were both significantly reduced 72 hours after therapy (P<0.05). However, the levels of blood triglyceride, C-reactive protein, TNF-α, IL-6, IL-8 and APACHE Ⅱ score of the patients in the HP+CVVH group were significantly lower than those in the CVVH group at the same time point (P<0.05). The hospital stay of the patients in the HP+CVVH group and CVVH group was significantly shorter than that in the control group (P<0.05). Compared with the CVVH group, the hospital stay of patients in the HP+CVVH group was significantly shorter (P<0.05). There was no statistical difference in organ dysfunction rate and mortality among the three groups (P>0.05). Conclusion Hemoperfusion combined with hemofiltration is an effective method for HLSAP by cleaning the inflammatory mediators availably and inhibiting the excessive inflammatory reaction.
Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
ObjectiveTo investigate the effect of polymyxin B hemoperfusion on the prognosis of patients with sepsis and septic shock by meta-analysis.MethodsSupplemented by manual search and document traceability, the US National Library of Medicine Pubmed, the Dutch Medical Abstracts Embase database, and the Cochrane clinical trial database were searched. Randomized controlled trials (RCTs) were collected from January 1998 to October 2018 for the treatment of sepsis and septic shock with polymyxin B hemoperfusion, only limited to English publications. The collected RCTs were evaluated and the prognosis of patients with sepsis and septic shock was analyzed by the Cochrane Collaboration.ResultsFinally six RCTs were included, and a total of 926 patients were analyzed, with 471 patients in the polymyxin B hemoperfusion group and 455 patients in the control group. The mortality rate was 36.3% (171/471) in the polymyxin B hemoperfusion group and 39.1% (178/455) in the control group. Hemoperfusion with polymyxin B could not reduce the patient mortality (RR=0.80, 95% CI 0.56 to 1.15, P=0.233). A subgroup analysis was taken on the patients with moderate to severe septic shock. Four RCTs were included in total and 418 patients were analyzed, with 207 patients in the polymyxin B hemoperfusion group and 211 in the control group. The mortality rate was 38.65% (80/207) in the polymyxin B hemoperfusion group and 50.71% (107/211) in the control group were. The hemoperfusion of polymyxin B could significantly reduce the mortality of patients with moderate to severe septic shock (RR=0.70, 95% CI 0.52 to 0.96, P=0.025).ConclusionsOlymyxin B hemoperfusion can not improve the prognosis of patients with sepsis and septic shock. However, compared with conventional treatment, polymyxin B hemoperfusion can improve the 28-day mortality rate of patients of severe septic shock. Due to the limit number of randomized controlled trials, more high-quality trials are needed to a further confirmation.