The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, la...The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.展开更多
多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)已成为临床死亡的主要原因,是目前国际医学界研究热点之一,本文主要介绍了TNF-α、IL-10、基质金属蛋白酶的生物学作用以及它们与MODS的关系,为MODS的治疗和研究提供一...多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)已成为临床死亡的主要原因,是目前国际医学界研究热点之一,本文主要介绍了TNF-α、IL-10、基质金属蛋白酶的生物学作用以及它们与MODS的关系,为MODS的治疗和研究提供一些参考。展开更多
目的探讨失血性休克合并内毒素血症"二次打击"致多器官功能衰竭(multiple organ dysfunctionsyndrome,MODS)时兔循环内皮细胞(CEC)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血气指标的变化及其相关性。方法选择新西兰...目的探讨失血性休克合并内毒素血症"二次打击"致多器官功能衰竭(multiple organ dysfunctionsyndrome,MODS)时兔循环内皮细胞(CEC)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血气指标的变化及其相关性。方法选择新西兰兔24只,随机分为对照组、休克组、MODS组3组,每组8只。休克组给予股动脉放血,1h后回输。MODS组于回输后腹腔注射内毒素。对照组给予腹腔注射生理盐水。48h后取静脉血检测CEC的含量及各组血清IL-6及TNF-α的浓度,取动脉血测定各组pH值、氧分压(PO2)和二氧化碳分压(PaCO2)。结果 MODS组中CEC的含量、IL-6和TNF-α的浓度均高于对照组和休克组(P<0.05),MODS组中pH值和PaCO2下降幅度也较对照组和休克组明显。相关性分析显示,CEC与血清IL-6和TNF-α的浓度呈正相关性(r=0.538,0.627),与PaCO2的改变呈负相关(r=-0.543)。结论 "二次打击"致MODS时血管内皮细胞损伤与炎症因子的释放和血气指标的变化具有一定的相关性。展开更多
文摘The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.
文摘目的探讨失血性休克合并内毒素血症"二次打击"致多器官功能衰竭(multiple organ dysfunctionsyndrome,MODS)时兔循环内皮细胞(CEC)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血气指标的变化及其相关性。方法选择新西兰兔24只,随机分为对照组、休克组、MODS组3组,每组8只。休克组给予股动脉放血,1h后回输。MODS组于回输后腹腔注射内毒素。对照组给予腹腔注射生理盐水。48h后取静脉血检测CEC的含量及各组血清IL-6及TNF-α的浓度,取动脉血测定各组pH值、氧分压(PO2)和二氧化碳分压(PaCO2)。结果 MODS组中CEC的含量、IL-6和TNF-α的浓度均高于对照组和休克组(P<0.05),MODS组中pH值和PaCO2下降幅度也较对照组和休克组明显。相关性分析显示,CEC与血清IL-6和TNF-α的浓度呈正相关性(r=0.538,0.627),与PaCO2的改变呈负相关(r=-0.543)。结论 "二次打击"致MODS时血管内皮细胞损伤与炎症因子的释放和血气指标的变化具有一定的相关性。
