持续动静脉血液滤过治疗内源性休克的疗效。

Circulatory shock Pub Date : 1994-12-01
S M Heidemann, J P Ofenstein, A P Sarnaik
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摘要

我们确定了持续动静脉血液滤过(CAVH)在去除肿瘤坏死因子(TNF)、血栓素A2和前列环素方面的疗效,并提高了内毒素血症患者的生存率。12只大鼠给予10 mg/kg大肠杆菌0:27:B8脂多糖。15min后,将大鼠随机分为超滤组和非超滤组。采集血液和超滤液检测TNF、血栓素B2 (TxB2)和6-酮-前列腺素F1 α(6-酮- pgf1 α)。4小时后处死存活大鼠。6只超滤大鼠中5只存活4小时,6只非超滤大鼠中无一存活。血浆TxB2 > 1,000 pcg/ml,前2h内升高率预测死亡(P < 0.03)。超滤降低了TxB2升高速率(P < 0.04)。血浆TxB2与超滤清除TxB2呈负相关。TNF和6-keto-PGF1 α的浓度和增加速率不能预测生存率。我们得出结论,CAVH可提高内毒素血症患者的短期生存率。有益的效果似乎是由于血栓素A2的去除。
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Efficacy of continuous arteriovenous hemofiltration in endotoxic shock.

We determined the efficacy of continuous arteriovenous hemofiltration (CAVH) in removing tumor necrosis factor (TNF), thromboxane A2, and prostacyclin, and in improving survival in endotoxemia. Twelve rats were given 10 mg/kg of E. coli 0:127:B8 lipopolysaccharide. Fifteen min later, the rats were randomized to ultrafiltered or non-ultrafiltered groups. Blood and ultrafiltrate were collected for TNF, thromboxane B2 (TxB2), and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). After 4 hr, surviving rats were sacrificed. Five of 6 ultrafiltered and none of 6 non-ultrafiltered rats survived 4 hr. Plasma TxB2 > 1,000 pcg/ml and its rate of increase within the first 2 hr predicted death (P < 0.03). Ultrafiltration decreased the rate of rise in TxB2 (P < 0.04). Plasma TxB2 inversely correlated with TxB2 clearance by ultrafiltration. The concentration and rate of increase in TNF and 6-keto-PGF1 alpha did not predict survival. We conclude that CAVH improves short term survival in endotoxemia. Salutary effects appear to be due to thromboxane A2 removal.

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Comparison of binding specificity and the function of two human IgM anti-lipid A monoclonal antibodies. Hypertonic saline/dextran versus lactated Ringer's treatment for hemorrhage in dehydrated swine. Lysozyme regulates LPS-induced interleukin-6 release in mice. Liver oxygen uptake dependence and mitochondrial function in septic rats. Efficacy of continuous arteriovenous hemofiltration in endotoxic shock.
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