切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2025, Vol. 11 ›› Issue (02) : 210 -216. doi: 10.3877/cma.j.issn.2096-1537.2025.02.020

病例报告

SET 对高炎症、高SOFA 并顽固性休克的脓毒症患者救治一例并文献复习
胡青1, 周东旭1, 黄梅1, 秦进成1, 石伟1, 马朋林1,()   
  1. 1. 550000 贵阳,贵黔国际医院重症医学科
  • 收稿日期:2025-01-07 出版日期:2025-05-28
  • 通信作者: 马朋林

The value of sequential extracorporeal therapy in management of septic patients phenotyping with hyperinflammation,high SOFA and refractory shock:a case report and systematic literature review

Qing Hu1, Dongxu Zhou1, Mei Huang1, Jincheng Qin1, Wei Shi1, Penglin Ma1,()   

  1. 1. Department of Critical Care Medicine,Guiqian International Hospital,Guiyang 550000,China
  • Received:2025-01-07 Published:2025-05-28
  • Corresponding author: Penglin Ma
引用本文:

胡青, 周东旭, 黄梅, 秦进成, 石伟, 马朋林. SET 对高炎症、高SOFA 并顽固性休克的脓毒症患者救治一例并文献复习[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 210-216.

Qing Hu, Dongxu Zhou, Mei Huang, Jincheng Qin, Wei Shi, Penglin Ma. The value of sequential extracorporeal therapy in management of septic patients phenotyping with hyperinflammation,high SOFA and refractory shock:a case report and systematic literature review[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(02): 210-216.

回顾性分析2024 年3 月21 日贵黔国际医院收治的1 例因尿路感染所导致的脓毒症休克患者的临床资料。以“脓毒症”+“血液净化”为关键词,在中国知网及万方数据库进行文献检索,以英文关键词“Sepsis”和“Blood purification”在PubMed 数据库进行文献检索,对具有上述特征的脓毒症患者亚组使用或不使用SET 对预后的影响进行比较分析。结果显示,该例患者具有鲜明的“高炎症因子表达+器官损伤迅速进展+顽固性休克”临床特征,在规范执行脓毒症集束化治疗的基础上,SET 能迅速逆转循环以及其他重要器官功能,预后良好。文献复习共检索到具有上述特征的患者12例,8 例患者在使用SET 后病情迅速好转,其余4 例患者因其他严重并发症死亡。同时检索到队列研究分析4 篇,整合结果显示,SET 有利于降低炎症因子水平、改善脓毒症预后。提示针对具有上述特征的脓毒症患者,在规范执行集束化治疗的前提下,SET 可能是改善临床结局有益的措施之一。

A retrospective analysis was conducted on the clinical data of a patient with septic shock due to a urinary tract infection admitted to Guiqian International Hospital on March 21,2024.Using the keywords “Sepsis” and “Blood purification”,a literature search was performed in the CNKI and Wanfang databases.A search with keywords “Sepsis” and “Blood purification” in title/abstract was also conducted in the PubMed database.Clinical outcomes were compared between groups receiving SET or not in patients phenotyping with the above characteristics.The results showed,this case was characterized with high expression of inflammatory factors,rapid progression of organ damage and refractory shock.Based on well implementing sepsis bundle,SET restored circulation and the other vital organ function rapidly,resulting in a favorable prognosis.A literature review searched out 12 cases with the similar characteristics to this case.Of them,8 patients showed rapid improvement of organ function and survival after receiving SET,but 4 patients died of severe complications.Additionally,4 cohort studies were recruited in the literature review.The pooled data demonstrated that SET significantly reduced inflammatory cytokines and improved patient outcomes.It was suggested that,based on well implementing bundles,SET could be one of the interventions beneficial to outcomes in septic patient phenotyping with the above characteristics.

图1 患者4 月4 日病情持续进展后所行泌尿系CT。示双肾多发稍低/低密度
表1 患者入科后3 次HP 联合CRRT 治疗期间病情变化
图2 患者双肾脓肿穿刺引流术中超声影像图。右上角为穿刺后取出的双侧肾脏脓肿
表2 文献复习检索的12 例患者归纳对比
图3 检索文献筛选流程图
图4 IL-6 水平变化森林图。有3 篇队列研究比较血液灌流治疗对IL-6 水平的影响,共纳入328 例患者。各研究间异质性较大(P<0.000 01,I 2 =91%),故选用随机效应模型,分析结果提示灌流组患者IL-6 水平明显下降,差异具有统计学意义(MD=-19.70,95%CI=-23.60~-15.80,P<0.000 01) 注:IL-6 为白介素6
图5 PCT 水平变化森林图。有4 篇队列研究比较血液灌流治疗对PCT 水平的影响,共纳入404 例患者。各研究间异质性较大(P<0.000 01,I2 =98%),故选用随机效应模型,分析结果提示灌流组患者PCT 水平明显下降,差异具有统计学意义(MD=-2.03,95%CI=-2.63~-1.43,P<0.000 01) 注:PCT 为降钙素原
1
De Rosa S,Cutuli SL,Lorenzin A,et al.Sequential extracorporeal therapy in Sepsis [J].Contrib Nephrol,2023,200:149-159.
2
Foster DM,Kellum JA.Endotoxic septic shock:diagnosis and treatment [J].Int J Mol Sci,2023,24(22):16185.
3
Evans L,Rhodes A,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock 2021 [J].Intensive Care Med,2021,47(11):1181-1247.
4
Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016 [J].Intensive Care Med,2017,43(3):304-377.
5
Levy MM,Evans LE,Rhodes A.The surviving sepsis campaign bundle:2018 update [J].Intensive Care Med,2018,44(6):925-928.
6
Chousterman BG,Swirski FK,Weber GF.Cytokine storm and sepsis disease pathogenesis [J].Semin Immunopathol,2017,39(5):517-528.
7
Diorio C,Shaw PA,Pequignot E,et al.Diagnostic biomarkers to differentiate sepsis from cytokine release syndrome in critically ill children [J].Blood Adv,2020,4(20):5174-5183.
8
Ronco C,Chawla L,Husain-Syed F,et al.Rationale for sequential extracorporeal therapy (SET) in sepsis [J].Crit Care,2023,27(1):50.
9
Burov AI,Abramov TA,Kostritca NS,et al.Observational case series:six neurosurgical patients with septic shock demonstrating clinical improvement after a combination of standard care and blood purification [J].Eur J Med Res,2021,26(1):151.
10
Włochacz B,Rybak A,Próchnicka A,et al.Dual blood purification with CytoSorb and oXiris in managing recurrent septic shock:a case report [J].Am J Case Rep,2025,26:e945952.
11
Tang ZQ,Zhao DP,Dong AJ,et al.Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function:a case report [J].World J Clin Cases,2023,11(27):6515-6522.
12
Ramírez-Guerrero G,Baghetti-Hernández R,Godoy-Tello C,et al.COVID-19,shock séptico refractario y terapia extracorpórea de purificación sanguínea con OXIRIS® [Management of refractory septic shock with blood purification therapy using a special filter.Report of one case [J].Rev Med Chil,2022,150(2):266-270.
13
Sinkovic A,Kit B,Markota A.Successful use of combined blood purification techniques in splenectomised patient with septic shock in streptococcus pneumoniae infection - a case report [J].BMC Infect Dis,2018,18(1):433.
14
De Rosa S,Samoni S,Ronco C.Sequential extracorporeal therapy collaborative device and timely support for endotoxic,septic,and cardiac shock:a case report [J].Blood Purif,2020,49(4):502-508.
15
Tang Y,Zhang L,Fu P,et al.Hemoperfusion plus continuous venovenous hemofiltration in a pregnant woman with severe acute pancreatitis:a case report [J].Int Urol Nephrol,2012,44(3):987-90.
16
黄少辉,张杰灵,陈业媛.连续性肾脏替代治疗联合HA-380 血液灌流治疗脓毒症的效果及对炎症因子的影响 [J].中国当代医药,2023,30(31):46-49.
17
刘兴红.CRRT 联合血液灌流在脓毒症相关急性肾损伤治疗中的临床应用回顾性研究 [D].四川南充:川北医学院,2023.
18
黄长利,黄启伟,祝治华.HA380 血液灌流联合连续性静脉-静脉血液滤过对脓毒症合并急性肾损伤患者肾功能和炎症反应的影响[J].中国医学创新,2023,20(32):10-14.
19
程小敏,余旭,陈钰.连续性床旁血液净化对脓毒症患者脏器功能及炎症因子水平的影响 [J].中国实用医刊,2020,47(12):75-77.
20
Hellman T,Uusalo P,Järvisalo MJ.Renal replacement techniques in septic shock [J].Int J Mol Sci,2021,22(19):10238.
21
周苏,蒋永泼,戴罕之,等.脓毒症表型研究新进展 [J].实用医学杂志,2022,38(7):804-808.
22
Scicluna BP,van Vught LA,Zwinderman AH,et al; MARS Consortium.Classification of patients with sepsis according to blood genomic endotype:a prospective cohort study [J].Lancet Respir Med,2017,5(10):816-826.
23
Seymour CW,Kennedy JN,Wang S,et al.Derivation,validation,and potential treatment implications of novel clinical phenotypes for sepsis[J].JAMA,2019,321(20):2003-2017.
24
Famous KR,Delucchi K,Ware LB,et al.Acute respiratory distress syndrome subphenotypes respond differently to randomized fluid management strategy [J].Am J Respir Crit Care Med,2017,195(3):331-338.
25
Lilly CM.Protocol-based care for early septic shock [J].N Engl J Med,2014,371(4):386-387.
26
Chaiwut R,Kasinrerk W.Very low concentration of lipopolysaccharide can induce the production of various cytokines and chemokines in human primary monocytes [J].BMC Res Notes,2022,15(1):42.
27
Shakoory B,Carcillo JA,Chatham WW,et al.Interleukin-1 receptor blockade is associated with reduced mortality in sepsis patients with features of macrophage activation syndrome:reanalysis of a prior phase Ⅲ trial [J].Crit Care Med,2016,44(2):275-281.
28
石颖慧,牛文凯,苑鑫.脓毒症中细胞因子风暴的机制及治疗研究进展 [J].军事医学,2023,47(8):626-630.
29
Zhang J,Ge P,Liu J,et al.Glucocorticoid treatment in acute respiratory distress syndrome:an overview on mechanistic insights and clinical benefit [J].Int J Mol Sci,2023,24(15):12138.
30
Sevransky JE,Rothman RE,Hager DN,et al.Effect of Vitamin C,Thiamine,and Hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis:the VICTAS randomized clinical trial [J].JAMA,2021,325(8):742-750.
31
魏逸凡,王敏敏.脓毒症体外血液净化技术发展现状 [J].中国医疗器械信息,2024,30(23):55-59.
[1] 陈瑞, 王丽, 徐海乐, 许彬, 陈超, 陆件. 早期监测白细胞介素35 联合肝素结合蛋白对脓毒症相关急性肾损伤的预测价值[J/OL]. 中华危重症医学杂志(电子版), 2025, 18(02): 122-127.
[2] 贾艳慧, 原毅轩, 官浩, 胡大海. 清除衰老细胞在减轻脓毒症小鼠急性肺损伤中的作用机制探讨[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(01): 55-60.
[3] 唐浩然, 周彪, 巴特, 李洋洋. 严重烧伤后脓毒症早期诊断相关生物标记物的研究进展[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(01): 70-74.
[4] 王鹏森, 吴慧锋, 温建芳, 韦阳, 董龙浩, 刘博强, 李占, 石春锋, 雷晓栋, 吴雄雄. 脓毒症并发急性肺损伤血清miR-146a 的表达及与预后相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(02): 241-245.
[5] 绳春佳, 陈雨浩, 彭飞, 夏纪凯, 李晓帆, 陈健文, 张楚悦, 吴玲玲, 刘娇娜, 白雪源, 陈香美. 表没食子儿茶素没食子酸酯通过抑制细胞衰老改善小鼠急性肾损伤[J/OL]. 中华肾病研究电子杂志, 2025, 14(03): 133-139.
[6] 李菲, 郭晓夏, 郑悦, 郑爔, 李鑫成, 李文雄. 他汀类药物对甘油三酯葡萄糖指数增高的脓毒症相关急性肾损伤患者预后的影响[J/OL]. 中华肾病研究电子杂志, 2025, 14(02): 68-76.
[7] 杨穗碧, 杨杰, 周鹏敏, 陈棚棚, 沈鸿杰, 薛栋, 章仲恒. 重症医学的多组学和表型:改变学科发展模式[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 134-138.
[8] 徐优, 郭强. 脓毒症肺损伤治疗:突破与创新的必要性[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 152-156.
[9] 张建成, 谢冰, 尚游. 细胞迁移:脓毒症肠-肺交互作用的关键机制[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 163-166.
[10] 林瑾, 赵宸龙, 岳之琳, 段美丽. 接受CRRT 的SAKI 危重患者早期死亡的危险因素及其预测价值[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 186-192.
[11] 张优佳, 丁明月, 刘之琪, 郑帅歌, 刘仕豪, 秦秉玉. PD-1/PD-L1 通路在脓毒症导致的脏器功能障碍中的作用[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 198-203.
[12] 张丽娜, 谌楚宇, 杨新宇, 邱海波, 吕奔. 脓毒症凝血功能障碍:2024 年度进展与展望[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 105-111.
[13] 张玲, 谢剑锋. 脓毒症神经免疫互作与器官损伤:2024 年度进展与展望[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 112-116.
[14] 王浩, 黄咪, 李雪琴. SIGIRR、IL-1、Treg/Th17、NLR与急性胰腺炎继发脓毒症病情程度及预后的关联性[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(03): 250-255.
[15] 欧范妍, 郭乾, 曾莉雄, 陈秋莉, 甘厚玉, 杨洁. 基于机器学习和转录组学综合分析线粒体自噬和铁死亡关键基因在成人脓毒症诱导ARDS中的免疫调控作用机制[J/OL]. 中华卫生应急电子杂志, 2025, 11(02): 86-101.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?