腹部救急疾患における急性血液浄化法の終了・離脱条件について

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  • Conditions for Completion / Withdrawal from Acute Blood Purification Therapy in Abdominal Diseases Requiring Emergent Care.

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[Aim] To determine useful parameters for deciding when to withdraw acute apheresis therapy from patients with acute renal failure associated with abdominal disease, we evaluated the changes in parameters related to renal and non-renal functions in these patients. [Methods] Twenty patients with severe abdominal diseases who developed acute renal failure underwent acute apheresis therapy at our institution between 1994 and 2001. Seven of these patients were males and 13 were females, with a mean age of 76.7 years. Eleven parameters (leukocyte count, platelet count, base excess, blood urea nitrogen level, serum creatinine level, APACHE II score, septic severity score (SSS), serum bilirubin level, PaO2, urine volume per hour, and mean blood pressure) were compared before induction and after the withdrawal of apheresis therapy. [Results] Continuous Hemodiafiltration (CHDF) and endotoxin adsorption (PMX) were applied in 17 cases. Among the parameters assessed, the platelet count, SSS, urine volume per hour, PaO2, and mean blood pressure significantly improved with treatment (p<0.05). The platelet count, urine volume per hour, PaO2, and mean blood pressure are related to the functions of four of the seven organs included in SSS evaluations. [Conclusion] These data indicate that SSS, a parameter of the severity of infectious disease, is a useful single factor for deciding when to terminate acute apheresis therapy.

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