多臓器不全に対する血液浄化法(<特集>多臓器不全とアフェレシス)

概要

論文の詳細を見る
The relationships between incidence of organ failure and mortality until 28 hospital days were examined in critical ill patients. Plasma exchange (PE) was performed in 32 cases with acute hepatic failure, direct hemoperfusion using polymyxin-B immobilized fiber (PMX) in 45 cases with severe sepsis, or continuous hemo (dia) filtration (CH(D)F) in 39 cases with acute renal failure. Each organ (respiratory, coagulation, hepatic, cardiovascular, neurologic, and renal) system was re-analyzed by sequential organ failure assessment (SOFA) before the first therapeutic apheresis, and defined as organ failure when the SOFA score was 3 or 4. Of the PE group, hepatic failure was defined in 30 cases and their mortality was 53%, coagulation failure in 19 cases and 74%. Of the PMX group, cardiovascular failure was defined in 28 cases and their mortality was 46%, coagulation failure in 26 cases and 46%. Of the CHDF group, respiratory failure was defined in 39 cases and their mortality was 56%, renal failure in 24 cases and 58%. These organ failures showed relatively higher incidence and lower mortality in each group. The mean number of failing organs was 3.4 in PE, 2.6 in PMX and CHDF group. Therefore each therapeutic apheresis should be started in the case of least two organ failures.
日本アフェレシス学会の論文
2004-02-29