ダイチョウ センコウ ショウレイ ニ タイスル エンドトキシン キュウチャク リョウホウ ノ ケントウ

The aim of this retrospective study was to investigate the therapeutic results of Polymyxin Bimmobilized Direct Hemoperfusion（PMX-DHP）for colorectal perforation. The study subjects were 40 patients with colorectal perforation surgically treated from 1993 through 2004, of whom 18 underwent PMX-DHP after operation（P group）and 22 underwent operations only（N group）. Although there was no significant difference between the two groups in the overall mortality rate, the mortality rate for ARDS was significantly lower in the P group than in the N group. There was a statistically significant correlation between the P/F ratio and the time interval from the disease onset（r=－0.590, p=0.0009<0.001）. The time lag from disease onset to operation and the length of PMX-DHP period were significantly longer in the death group than in the survivor group. We anticipate that PMX-DHP for colorectal perforation proves effective in reducing deaths from ARDS. For an effective facilitation of PMX-DHP, the procedure should be started as soon as possible from the onset of the disease

Sivelestat Sodium Hydrate ト エンドトキシン キュウチャク リョウホウ トノ ヘイヨウ リョウホウ ガ ユウヨウ デ アッタ ARDS ノ イチレイ

We report here a case of Acute Respiratory Distress Syndrome（ARDS）due to perforation of the sigmoid colon, for which therapy with Sivelestat Sodium Hydrate（SSH, Elaspol）and Polymyxin B-immobilized Direct Hemoperfusion（PMX-DHP）was shown to be effective. An 88-yearold woman was admitted to our hospital because of abdominal pain. Abdominal computed tomography showed free air present in the liver and near the sigmoid colon. These results suggested sigmoid colon perforation, and we performed Hartmann’s operation and drainage. After operation, her blood pressures and the PaO2/FiO2 ratio decreased. The patient was then diagnosed septic shock and ARDS ; and PMX-DHP was performed, followed by the initiation of SSH administration. After therapy, she showed improvements in her conditions of septic shock and ARDS. It is inferred that therapy with PMX-DHP and SSH is effective for ARDS in view of an observed two-fold suppression in vascular endothelial cell damage