Successful treatment of linezolid-induced severe lactic acidosis with continuous venovenous hemodiafiltration: A case report

Linezolid is an oxazolidinone antibiotic. Linezolid-associated lactic acidosis has been reported in 6.8% of linezolid-treated patients. Lactic acidosis is associated with poor clinical outcomes, with high blood lactate levels resulting in organ dysfunction and mortality. This case report describes the development of lactic acidosis in a 64-year-old Chinese woman who had received 33 days of treatment with antituberculosis drugs and 28 days of treatment with oral linezolid for tuberculous meningitis. Severe lactic acidosis was reversed by withdrawing antituberculosis drugs and using continuous venovenous hemodiafiltration (CVVH). When the patient's condition was stable, she was transferred to the infectious disease department, and antituberculosis drugs, with the exception of linezolid, were reintroduced. This did not result in recurrence of lactic acidosis. The causal relationship between lactic acidosis and linezolid was categorized as ‘probable’ on the Adverse Drug Reaction Probability Scale. This case demonstrates that CVVH has potential as an alternative to discontinuation of linezolid alone for rapid reversal of linezolid-associated severe lactic acidosis.     

连续性静脉-静脉血液滤过在48例难治性心力衰竭患者中的治疗作用

目的探讨连续性静脉-静脉血液滤过(CVVH)对难治性心力衰竭患者的治疗作用及安全性。方法48例难治性心力衰竭患者经常规强心、利尿等治疗效果不佳后接受CVVH治疗共167例次。观察治疗前后心率、血压、呼吸频率、肺部罗音、肝颈静脉回流征和水肿等的变化,并判断心功能的改变;测定治疗前、后左心室射血分数、肾功能及电解质等。结果经CVVH治疗后大部份患者(77.1%)呼吸困难缓解,心率逐渐恢复,血压维持正常,肺部罗音减少,肝颈静脉回流征转为阴性,水肿消退,左心室射血分数增加,心功能从Ⅳ级提高到Ⅱ~Ⅲ级;38例合并肾功能不全的患者经CVVH治疗后血尿素氮、肌酐降低;28例合并电解质紊乱者经治疗后高钾血症和低钠血症得到纠正。9例合并严重心律失常的患者有6例经CVVH治疗后心率、心律恢复正常。结论CVVH能平稳地清除水分及溶质并保持血流动力学的稳定,可以安全有效地应用于难治性心力衰竭的治疗。     

Continuous hemodiafiltration therapy reduces damage of multi-organs by ameliorating of HMGB1/TLR4/NFκB in a dog sepsis model

In the present study, we investigated whether CVVH can reduce HMGB1, TLR4, NF-κB and other serum cytokine levels, preventing organ injury in a dog sepsis model. A total of 10 dogs were injected with LPS and treated with either CVVH group (n = 5) or nothing (Control, n = 5) for 24 h. EILSA was used for examining the concentration of TNF-α, IL-6, HMGB 1 and TLR4. The histological change of lung, liver and kidney tissues was determined. The mRNA expression of HMGB1, TLR4 and NF-κB was examined by RT-PCR. The protein of HMGB1 and phosphated NF-κB was examined by Western-blot. The levels of serum HMGB1 came to the peak at 8 h, 16 h and then declined. The LPS-induced increase in HMGB1 level was suppressed by CVVH compared with Control. Likewise, serum TNF-α and IL-6 levels decreased with CVVH along with a significant improvement in the function of main organs. Histologic examination revealed significant reduction in inflammation in lung; liver and kidney tissues harvested 24 h after CVVH compared with Control. The mRNA of HMGB1, TLR4 and NF-κB in the kidney was expressed at high level after LPS administration, which was significantly decreased by CVVH. The increased protein expression of HMGB1 and phosphated NF-κB was reduced after CVVH compared with control. CVVH by reducing the level of HMGB1, TLR4, NF-κB and other cytokines could weaken the cascade of cytokines and restore the immune system, and reduce the damage of important organs in sepsis.     

SLED与CVVH血液动力学比较

目的比较持续缓慢低效血液透析(SLED)与持续静脉静脉血液滤过(CVVH)在重症肾衰竭患者治疗中的血液动力学变化。方法采用前瞻开放设计,交叉对照方法,以清洗期12～24h,20例重症肾衰竭患者分别被随机施以SLED和CVVH治疗10h,治疗全程每小时记录平均动脉压、心率、超滤率,记录一过性低血压的发生情况、血管活性药和胶体的使用情况。结果CVVH组平均超滤率(0.262±0.296)L/h,总超滤平均每例(3.296±1.953)L,平均动脉压(102.760±19.494)mmHg,平均心率(89.550±21.203)次/min,一过性低血压发生率16/20;SLED组平均超滤率(0.420±0.333)h,总超滤平均每例(5.403±2.956)L,平均动脉压101.438±19.331,平均心率97.705±21.799,一过性低血压发生率15/20;SNK方差分析显示SLED组每小时超滤率、总超滤率、心率比CVVH组显著增高(P<0.01);但两组治疗之间MAP无差异(P>0.01)。结论SLED在重症肾衰竭患者治疗中血液动力学像CVVH一样稳定,甚至在总超滤量明显大于CVVH时也未明显增多低血压的发生。     

低血小板危重患者连续性血液净化的抗凝探讨

目的　探讨不同抗凝方法对伴有低血小板症的多脏器功能障碍综合征 (MultipleOrganDysfunctionSyndrome ,MODS)患者进行连续性血液净化时的抗凝效果。方法　将 12例伴有低血小板症的MODS患者进行的 5 4人次的连续性静静脉血液滤过 (CVVH)分为四组 :小剂量肝素组 (LDH)、低分子量肝素组 (LMWH)、无肝素 (NH)和小剂量低分子量肝素加盐水冲洗组 (COM) ,观察各组 12h内的抗凝效果、出血情况和血小板的变化。结果　NH组体外循环凝血发生率较其它组高 (P <0 .0 5 )。LDH组和LMWH组早期出血明显 ,NH组后期出血明显 ,COM组治疗前后则无明显变化 ,但与其它三组比较 ,COM组的出血次数明显减少 (P <0 .0 5 )。CVVH过程中 ,各组的凝血酶原活动度 (Pa)明显回升 (P <0 .0 5 ) ,除LDH组外 ,其它三组的血浆部分凝血活酶时间 (APTT)、凝血酶原时间 (PT)及凝血酶时间 (TT)逐渐降至正常。NH组血小板数下降显著 (P<0 .0 5 ) ,而肌酐清除不明显。结论　伴有低血小板症的MODS患者进行连续性血液净化时 ,小剂量低分子量肝素加盐水冲洗的抗凝效果较好、不增加出血危险、对血小板影响小     

连续性静脉-静脉血液滤过患者血清中利奈唑胺的浓度监测

目的:对连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)治疗的危重患者进行利奈唑胺血药浓度监测,为临床个体化治疗提供依据。方法:建立高效液相色谱法(以左氧氟沙星为内标),测定患者血清中利奈唑胺谷浓度。结果:利奈唑胺在0.31～20.00μg.mL-1内线性关系良好(r=0.999 5),定量限为0.31μg.mL-1。5例危重患者在治疗期间监测23次的利奈唑胺谷浓度变化明显,变化范围为1.53～17.10μg.mL-1。有2例患者谷浓度变化较大(相差近5倍)。结论:高效液相色谱法简单、快速、准确、灵敏、重复性好,可用于临床利奈唑胺的血药浓度监测。进行连续性静脉-静脉血液滤过治疗的患者,应用利奈唑胺时血药浓度变化较大,需要通过治疗药物监测的方法制定个体化给药方案。     

血液滤过在急性重症胰腺炎治疗中的应用

目的 探讨连续性静脉-静脉血液滤过(CVVH)在重症急性胰腺炎(SAP)治疗中的应用.方法 回顾性分析25例SAP患者,采用常规综合治疗的同时行CVVH,观察临床症状、治疗前后APACHEII评分及血生化指标的变化.结果 CVVH治疗过程中,25例SAP患者呼吸窘迫、烦躁、谵妄、腹痛、腹胀等症状逐渐缓解;与治疗前比较,治疗后APACHEII评分差异有显著性(P＜0.05);25例SAP患者经CVVH治疗24h后,血总胆红素(TB)、AST、AMS、APS均明显降低,与治疗前比较差异具有显著性(P＜0.05).结论 SAP患者早期及时、有效行CVVH等综合治疗,能有效缓解临床症状、改善生化指标、有助于维持水、电解质、酸碱平衡、内环境以及微循环稳定、改善心、肺、肾功能,是安全、有效的治疗措施之一.