目的 探讨血液灌流器HA380进行血液灌流联合连续性静脉-静脉血液透析滤过(continuous veno-venous hemodiafiltration，CVVHDF)技术对于脓毒症休克捐献者肝功能的维护作用，旨在提高脓毒症休克捐献者肝的利用率。 方法 回顾性分析2020年11月─2022年11月青岛大学附属医院33例成功捐献器官的脓毒症休克捐献者临床资料，所有捐献者均接受HA380联合CVVHDF技术进行器官功能维护治疗，观察脓毒症休克捐献者治疗前后炎症反应、肝功能指标的变化。 结果 与治疗前相比，治疗后脓毒症休克捐献者白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、总胆红素(TB)水平均降低(t=12.462、6.252、6.995、3.305、6.360，均P＜0.001)；脓毒症休克捐献者的谷丙转氨酶(ALT)、谷草转氨酶(AST)治疗前后比较无统计学差异(t=0.035、0.930，P=0.972、0.356)。 结论 HA380联合CVVHDF技术用于脓毒症休克捐献者的脏器维护中效果明显，可降低炎症反应，改善供肝质量与脏器功能，一定程度上提升捐献者器官利用率。
Objective To explore the maintenance effect of HA380 hemoperfusion combined with continuous veno-venous hemodiafiltration (CVVHDF) on liver function of septic shock donors, in order to improve the utilization rate of liver of septic shock donors. Methods The clinical data of 33 septic shock donors who successfully donated organs in our hospital from November 2020 to November 2022 were retrospectively analyzed. All of them received HA380 combined with CVVHDF for organ function maintenance treatment, and the changes of inflammatory reaction and liver function indexes of septic shock donors before and after treatment were observed. Results Compared with before treatment, the levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin -6 (IL-6) and total bilirubin (TB) of septic shock donors decreased after treatment (t=12.462, 6.252, 6.995, 3.305, 6.360, P＜0.001). There was no significant difference in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) among donors with septic shock before and after treatment (t=0.035,0.930, P=0.972, 0.356). Conclusion HA380 combined with CVVHDF technology is effective in organ maintenance of septic shock donors, which can reduce inflammatory reaction, improve the quality of donor liver and organ function, and improve the organ utilization rate of donors to some extent.
[1]彭龙开.尸体器官捐献供体及器官评估和维护规范(2019版)[J].器官移植, 2019, 10(3):253-262.
[2]王海波,史赢,周稚烨,等.2019年中国器官捐献与移植等待现状分析[J].中华器官移植杂志, 2021, 42(6):324-325.
[3]朱乃庚,申振,孙胜红,等.单中心117例公民逝世后器官捐献供体资料临床分析研究[J].肝胆外科杂志, 2020,28(4):256-260.
[4]Font MD, Thyagarajan B, Khanna AK. Sepsis and Septic Shock - Basics of diagnosis, pathophysiology and clinical decision making[J].Med Clin North Am, 2020, 104(4):573-585.
[5]Gorordo-Delsol LA, Merinos-Sánchez G, Estrada-Escobar RA, et al. Sepsis and septic shock in emergency departments of Mexico: a multicenter point prevalence study[J].Gac Med Mex, 2020, 156(6):486-492.
[6]Gaudry S, Grolleau F, Barbar S, et al. Continuous renal replacement therapy versus intermittent hemodialysis as first modality for renal replacement therapy in severe acute kidney injury: a secondary analysis of AKIKI and IDEAL-ICU studies[J].Crit Care, 2022, 26(1):93.
[7]Yang J, Ji D, Zhu YQ, et al. Hemoperfusion with HA380 in acute type A aortic dissection patients undergoing aortic arch operation (HPAO): a randomized, controlled, double-blind clinical trial[J].Trials, 2020, 21(1):954.
[8]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学, 2013, 25(8):501-505.
[9]沈燕,李永峰,肖春华,等.多模态超声在脑死亡器官捐献移植肝术后监测中的应用[J].昆明医科大学学报, 2022, 43(9):90-95.
[10]朱昆仑,刘磊,尚文俊,等.合并急性肾损伤供者供肾零点活检评估及移植后临床效果分析[J].中华器官移植杂志, 2021, 42(12):717-722.
[11]誉铁鸥,曹泳文,毛克江,等.多种激素联合使用对脑死亡器官捐献供者血流动力学的影响[J].中华器官移植杂志, 2020, 41(8):474-476.
[12]范鹏飞,王清平,王洪海,等.器官捐献供者多重耐药菌感染对移植受者的影响[J].江苏医药, 2021, 47(7):684-689.
[13]桑珍珍,高杰,贾春梅,等.肝动脉阻力指数联和血清miRNA-122a对脓毒症休克合并肝损伤的诊断及预后价值[J].中华急诊医学杂志, 2020, 29(2):193-198.
[14]杜斌,夏奇奂,声跃,等.血清微小RNA-155-5p对脓毒症急性肝损伤患者预后的评估价值分析[J].中国医师进修杂志, 2020, 43(5):397-400.
[15]傅威,陈裕胜,曾军.吸附型CRRT滤器治疗肝脓肿继发脓毒症休克合并急性肾损伤1例[J].中国血液净化, 2019, 18(1): 63-65.
[16]刘磊,云云,燕宪亮,等.血液灌流联合连续性血液透析滤过对急性重度有机磷农药中毒患者器官功能的影响[J].临床急诊杂志, 2024, 25(2):51-56.
[17]李娜,朱雄,程远,等.MLKL-NLRP3炎症小体介导的坏死性炎症反应在脓毒症急性肺损伤小鼠中的作用及其机制[J].中华危重病急救医学, 2021, 33(5):523-528.
[18]Zaj?czkowska R, Zorska J, Serednicki W, et al. Use of Continuous Veno-Venous Hemodialysis (CVVHD) in Treatment of a Polytrauma Patient with Severe Hemophilia A[J].Am J Case Rep, 2022, 23:e934802.
[19]Ferrari F, Manera M, Villa G, et al. Safety and Effectiveness of Veno-Venous Extracorporeal Membrane Oxygenation Combined With Continuous Renal Replacement Therapy[J].ASAIO J, 2023, 69(4):360-365.
[20]Lorenzin A, de Cal M, Marcello M, et al. Vancomycin Adsorption during in vitro Model of Hemoperfusion with Mini-Module of HA380 Cartridge[J].Blood Purif, 2023, 52(2):174-182.
