重癥患者機(jī)體受到感染之后，炎性反應(yīng)呈級(jí)聯(lián)式放大，而人體為對(duì)抗炎癥反應(yīng)而形成的代償性反應(yīng)綜合征，一旦患者發(fā)生全身性炎性反應(yīng)與代償性抗炎反應(yīng)紊亂，可以導(dǎo)致其體內(nèi)的環(huán)境穩(wěn)態(tài)被破壞，出現(xiàn)組織損傷，最終出現(xiàn)多種器官的功能衰竭[1]。健帆公司針對(duì)不同類型危重癥患者提供吸附解決方案，健帆HA一次性血液灌流器，原研經(jīng)典，廣譜吸附，有效清除以炎癥介質(zhì)為代表的中大分子，可用于膿毒癥[2-3]、重癥急性胰腺炎（SAP）[4-5]、急性呼吸窘迫綜合征（ARDS）[6-7]等炎癥因子相關(guān)性疾病及心外科手術(shù)患者[8]；CA330細(xì)胞因子吸附柱，中國(guó)首個(gè)獲批醫(yī)療器械注冊(cè)證的細(xì)胞因子吸附類產(chǎn)品，專用于膿毒癥患者炎癥早期或細(xì)胞因子風(fēng)暴期。血液吸附危重癥領(lǐng)域治療模式多樣，臨床上可以根據(jù)實(shí)際情況單獨(dú)灌流使用，也可與其他血液凈化模式聯(lián)合使用，如HP+HD/HDF/CVVH、PFAD/CPFA[17]、(PFAD-HD)/ CPFA-CRRT[17]、HP+CPB、HP+ECMO，進(jìn)行全血或者血漿灌流治療。
參考文獻(xiàn)：
[1]Sasaki S，Hasegawa T，Kawarazaki H，et al． Development and validation of a clinical prediction rule for bacteremia among maintenance hemodialysis patients in outpatient setting［J］．PLoS One，2017，12( 1) : e0169975．
[2]Zhao Huang, Si-rong Wang, Zi-li Yang, and Ji-yun Liu. Effect on Extrapulmonary Sepsis-Induced Acute Lung Injury by Hemoperfusion With Neutral Microporous Resin Column[J]. Therapeutic Apheresis and Dialysis, 2012:1-8.
[3]Huang Z, Wang SR, Su W, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial.2010 Dec;14(6):596-602.
[4]Sun, Shiren, et al. "High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study." Annals of Saudi medicine 35.5 (2015): 352-358.
[5]Tang Y, Zhang L, Fu P, et al. Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report.[J]. International Urology & Nephrology,2012, 44(3):987-990.
[6]Xu, Xuefeng, et al. "Effect of HA330resin-directed hemoadsorption on a porcine acute respiratory distress syndrome model." Annals of intensive care 7.1 (2017): 84.
[7]Li, Cong, Nana Xu, and Tie Xu. "Therapeutic Effects of Hemoperfusion Combined with High Volume Hemofiltration on Acute Respiratory Distress Syndrome Short Title: Treatment of ARDS." Revista Argentina de Clinica Psicológica 29.3(2020):311.
[8]Zijian He, etal. The Efficacy of Resin Hemoperfusion Cartridge on Inflammatory Responses during Adult Cardiopulmonary Bypass. Blood Purif.2021 Jun 9;1-7.
[9]ZHANG Lin,et al.Clinical study of mechanical ventilation combined with hemoperfusion and purification in the treatment of pneumothorax complicated by respiratory failure caused by traffic accident.Chin J Emerg Resusc Disaster Med.2021.
[10]Yuan,Hai,et al."Efficacy of two combinations of blood purification techniques for the treatment of multiple organ failure induced by wasp stings."Blood Purification 42.1 (2016):49-55.
[11]Zijian He,et al.The Efficacy of Resin Hemoperfusion Cartridge on Inflammatory Responses during Adult Cardiopulmonary Bypass.Blood Purif.2021 Jun 9;1-7.
[12]Xu,Xuefeng,et al."Effect of HA330 resin-directed hemoadsorption on a porcine acute respiratory distress syndrome model."Annals of intensive care 7.1 (2017):84.
[13]Li,Cong,Nana Xu,and Tie Xu."Therapeutic Effects of Hemoperfusion Combined with High Volume Hemofiltration on Acute Respiratory Distress Syndrome Short Title:Treatment ofARDS."Revista Argentina de Clinica Psicológica 29.3 (2020):311.
[14]Wang,Y.T.,et al."Effects of hemodialysis and hemoperfusion on inflammatory factors and nuclear transcription factors in peripheral blood cell of multiple organ dysfunction syndrome."Eur Rev Med Pharmacol Sci 20.4 (2016):745-50.
[15]Huang Bin,et al.Clinical study of continuous veno-venous hemofiltration combined with hemoperfusion in the treatment of severe burn sepsis.Journal of Clinicalemergency(China).2019:1009-5918.
[16]Prof.Claudio Ronco.CENTRO SPECIALIZZATO REGIONALE.PER LE TERAPIE DIALITICHE NELL'INSUFFICIENZA RENALE ACUTA E CRONICA E PER LE TECNOLOGIE EXTRACORPOREE di SUPPORTO MULTI-ORGANICO.2020.
[17]Ronco, C., & Bellomo, R. (2022). Hemoperfusion: technical aspects and state of the art. Critical care (London, England), 26(1), 135. https://doi.org/10.1186/s13054-022-04009-w.
臨床應(yīng)用
急性中毒吸附解決方案
血液灌流可用于人體內(nèi)內(nèi)源性和外源性代謝產(chǎn)物、毒物及余量藥物的清除,已被寫入多項(xiàng)急性中毒專家共識(shí)，針對(duì)各類急性中毒患者，HA一次性血液灌流器，原研經(jīng)典，足程凈化，可用于有機(jī)農(nóng)藥中毒[1-5]、藥物中毒[6-7]、除草劑中毒[9-13]、毒蕈中毒[14-16]、蜂蟄傷[17]等急性中毒的搶救治療。臨床上可以利用多類血液凈化動(dòng)力裝置單獨(dú)灌流使用，也可與其他血液凈化器聯(lián)合使用，進(jìn)行全血或者血漿灌流治療?？稍诠嗔鳈C(jī)(JF-800A),Future F20血液凈化設(shè)備、透析機(jī)、CRRT機(jī)（如健帆DX-10）等多種血液凈化設(shè)備上完成治療。
參考文獻(xiàn)：
[1]楊立山,盧中秋,田英平,等.急性有機(jī)磷農(nóng)藥中毒診治臨床專家共識(shí)(2016)[J].中國(guó)急救醫(yī)學(xué),2016.
[2]張明浩,張偉,簡(jiǎn)偉明,等.血液灌流治療急性重度有機(jī)磷農(nóng)藥中毒安全性和有效性的Meta分析[J].醫(yī)學(xué)綜述,2020,26(14):8. [11]LI,Z.,WANG,G.,ZHEN,G.,etal.(2017).Applicationofhemoperfusioninsevereacuteorganophosphorus pesticidepoisoning.TURKISHJOURNALOFMEDICALSCIENCES,47,1277-1281.doi:10.3906/sag-1611-40.
[3]杜宇,牟奕,趙立強(qiáng).血液灌流治療次數(shù)對(duì)重度急性有機(jī)磷農(nóng)藥中毒療效和預(yù)后的影響[J].中國(guó)中西醫(yī)結(jié)合急救雜志,2013,20(5):289-292.
[4]趙宏宇,韓新飛,趙敏,等.血液灌流治療急性重度有機(jī)磷農(nóng)藥中毒的起始時(shí)間與療效的相關(guān)性研究[J].中國(guó)全科醫(yī)學(xué),2011.14(14):1603-1604.1607.
[5]李勇,吳征臻李龍急診床旁血液灌流治療老年鎮(zhèn)靜催眠類藥物中毒的療效[J].臨床急診雜志,2021,22(1):60-64.
[6]吳剛,陳陣劉易玨早期床旁血液灌流治療急性抗精神病藥物中毒的臨床觀察[J].現(xiàn)代醫(yī)藥衛(wèi)生,2015,31(7):1042-1044.
[7]郭利濤,劉昱,張蕾,王雪,等.血液灌流救治百草枯中毒方法探討[J].重慶醫(yī)學(xué),2013,42(5):552-553.
[8]Chen AB, Li F, Di EM, Zhang X, Zhao QY, Wen J. Influence of strengthened hemoperfusion combined with continuous venovenous hemofiltration on prognosis of patients with acute paraquat poisoning: SHP + CVVH improve prognosis of acute PQ patients. BMC Pharmacol Toxicol. 2020 Jul 6;21(1):49.
[9]孫亮,燕彭波,李國(guó)峰,等.雙罐串聯(lián)血漿灌流對(duì)血漿百草枯清除效果的研究[J].中國(guó)血液凈化,2013,12(3):149-151.
[10]中國(guó)醫(yī)師協(xié)會(huì)急診醫(yī)師分會(huì).急性百草枯中毒診治專家共識(shí)(2013)[J].中國(guó)急救醫(yī)學(xué),2013,33(6):6.
[11]百草枯中毒診斷與治療'泰山共識(shí)'專家組,菅向東.百草枯中毒診斷與治療"泰山共識(shí)"(2014)[J].中國(guó)工業(yè)醫(yī)學(xué)雜志,2014(2):117-119.
[12]趙航,趙敏,急性毒蕈中毒的臨床分析[J].中國(guó)醫(yī)科大學(xué)學(xué)報(bào),2020,49(5):433-436.
[13]林潔羽,董偉,血液灌流聯(lián)合血液濾過與單純血液濾過治療重癥毒蕈中毒效果比較[J].廣州醫(yī)藥,2020,51(2):27-30.
[14]丁文飛,吳蔚樺,文莉,等,不同血液凈化方式治療毒蕈中毒的臨床觀察[J].廣州醫(yī)藥,2020,51(2):27-30.
[15]中國(guó)醫(yī)師協(xié)會(huì)兒科醫(yī)師分會(huì)血液凈化專業(yè)委員會(huì),兒童血液灌流臨床應(yīng)用專家共識(shí)[J].中國(guó)小兒急救醫(yī)學(xué),2018.25(8):8.
[16]中國(guó)毒理學(xué)會(huì)中毒與救治專業(yè)委員會(huì)中華醫(yī)學(xué)會(huì)湖北省急診醫(yī)學(xué)分會(huì),湖北省中毒與職業(yè)病聯(lián)盟.胡蜂螫傷規(guī)范化診治中國(guó)專家共識(shí)[J].中華危重病急救醫(yī)學(xué),2018,30(9):5.
[17]程輝,文申英,劉超.血液灌流聯(lián)合連續(xù)性腎臟替代治療在蜂蜇傷致橫紋肌溶解合并急性腎損傷中的應(yīng)用價(jià)值[J].臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志,2020,19(16):4.
