Successful Treatment With Continuous Enteral Protease Inhibitor in a Patient With Severe Septic Shock

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• 作者：Y.-T. Lee^a ; J. Wei^a ; Y.-C. Chuang^a ; C.-Y. Chang^a ; I.-C. Chen^a ; C.-F. Weng^a ; G.W. Schmid-Schö ; nbein^b ; ^{gwss@bioeng.ucsd.edu}
• 刊名：Transplantation Proceedings
• 出版年：2012
• 期刊代码：252_00411345
• 类别：med
• 出版时间：April, 2012
• 卷：44
• 期：3
• 页码：817-819
• 文件大小：346 K

摘要

Objective

The mortality rate among patients with septic shock is high despite current therapy. We present a case of Fournier's gangrene and septic shock at 4 years post-heart transplantation that was reversed by 鈥渃ontinuous enteral feeding鈥?of the digestive enzyme inhibitor, gabexate mesilate. Recently, powerful pancreatic digestive proteases in the lumen of the intestine have been identified as initiators of the systemic inflammatory response. Intraluminal inhibitions of the proteases significantly attenuates intestinal damage, system inflammation, and multiorgan failure in experimental forms of shock but it has not been tested in man.

Methods and results

Gabexate mesilate, a synthetic digestive protease inhibitor, was continuously administered in two liters of crystalloid solution to a patient by enteral feeding during septic shock. The condition and markers for shock due to sepsis reversed in a few days.

Conclusion

This case suggested that 鈥渆nteral鈥?digestive protease inhibition may decrease and even reverse the sequelae of shock and sepsis.