Title:
EXAMINATION OF 2 CASES ENFORCES ENDOTOXIN HEMOADSORPTION TREATMENT FOR SEPTIC SHOCK

Yukihiro MInagawa^none

1. Kuji Hospital

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Background:
Endotoxin hemoadsorption therapy (PMX-DHP) is widely enforced by clinical, and enforced to a variety of septicemia imperfect internal organs for septic shock. However, not establishing it still enough is a current state in the adjustment and the evaluation judgment. About the case who enforced the endotoxin adsorption treatment enforced by this department in two years recently, we add some document consideration and report according to no all scores of internal organs including the relation to the evaluation judgment this time.

Methods:
The example of the endotoxin adsorption treatment enforcement syndrome to enforce by this department between April, 2003 and March, 2005 is SIRS 2 cases of assuming the bacterial infection to be a cause. It was one example of punching large intestines and traumatic large intestines necrosis (multiple trauma) with abdominal compartment syndrome is one case. Flowing quantity 80-100ml/min of blood and an anti-coagulant were enforced for 2~3 hours by using nafamostat mesilate by the end toxin adsorption column's assuming Broodaccess to be V-V route with the femoral vein by all samples as an enforcement method, and using Toremikishin made by the Toray Medical company.

Results:
It was one living case, and one death case among two this cases of the case of the object syndrome. Renal failure had been amalgamated as coexisting illness in the death case before the operation. It was 58.5 years old on the age average, 1 man example, 1 female example, and time from the appearance of disease to the PMX-DHP enforcement beginning was 180 minutes. The laparotomy was enforced to all examples. SOFA(Sequential Organ Failure Assessment ) score (breath, coagulation, liver function, cardiovascular system, central nervous system, and kidney function) is from 8(pre-PMX-DHP) to 14(post-PMX-DHP), APACHE-II score is 25 to 23 in died case and from 9 to 10, 18 to 13 in lifesaving case. Coexisting complication case was difficult.

Conclusion:
①The rise of the APACHE-Ⅱ score was admitted though the effect and the effectiveness of PMX-DHP were evaluated with SOFA score and APACHE-Ⅱ score. ②It was thought that A Endotoxin　hemoadsorption treatment was useful for the improvement of the prognosis according to the collection academic treatment including the operation treatment and the septicemia measures.

Subject:
Hemodiafiltration

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