连续性高容量血液滤过治疗重度急性呼吸窘迫综合征的临床疗效

张继承，楚玉峰，曾娟，任宏生，孟玫，蒋进皎，王春亭.连续性高容量血液滤过治疗重度急性呼吸窘迫综合征的临床疗效[J].中华危重病急救医学,2013,25(3),1

连续性高容量血液滤过，急性呼吸窘迫综合征，氧合指数，血流动力学

张继承，楚玉峰，曾娟，任宏生，孟玫，蒋进皎，王春亭

济南，山东大学附属省立医院重症医学科

2013年

145-148

知网

探讨连续性高容量血液滤过(CHVHF)治疗重度急性呼吸窘迫综合征(ARDS)的临床疗效.方法 采用前瞻性随机对照研究方法,选择2007年6月至2011年6月入住本院重症监护病房(ICU)的65例重度ARDS患者进行研究,按照随机数字表法分 为治疗组(37例)和对照组(28例),对照组给予常规治疗,治疗组在常规治疗基础上应用CHVHF治疗.观察两组患者治疗前及治疗后6、24、48、 72 h肺功能指标氧合指数(PaO2/FiO2)、血管外肺水指数(EVLWI)、动脉血二氧化碳分压(PaCO2),以及血流动力学参数如心率(HR)、平 均动脉压(MAP)的变化,并观察机械通气的持续时间、住ICU天数、撤机成功率、28 d存活率等指标.结果 两组治疗后肺功能指标较治疗前均有明显改善,随治疗时间延长PaO2/FiO2(mm Hg,1 mm Hg=0.133kPa)逐渐升高,EVLWI (ml/kg)、PaCO2(mm Hg)逐渐下降,且治疗组较对照组改善明显(6 h PaO2/FiO2:92.6±7.2比83.8±11.4,24 h EVLWI:10.8±3.7比12.6±4.5,24 h PaCO2:47.2±8.5比51.4±4.8,均P＜0.05).两组治疗后血流动力学指标HR、MAP较治疗前明显改善,但两组间比较差异无统计学 意义.与对照组比较,治疗组机械通气时间(d)、住ICU天数(d)明显缩短(机械通气时间:12±4比19±6,住ICU天数:21±4比33±8,均 P＜0.05),撤机成功率、28 d存活率明显升高(撤机成功率:81.1％比64.3％,28 d存活率:86.5％比71.4％,均P＜0.05).结论 重度ARDS患者采用CHVHF治疗能明显改善肺功能,缩短机械通气时间,提高机械通气撤机成功率,降低病死率,对血流动力学无明显不利影响. To investigate the effect of continuous high-volume hemofiltration (CHVHF) in patientswith severe acute respiratory distress syndrome (_1RDS)Methods A prospective randomized controlled trial was conducted. Sixty-five patients with severe ARDS admitted to intensive care unit (ICU) from June 2007 to June 2011 were divided into conhol group (n=28) and treatment group (n=37). Patients in treatment group were treated with CHVHF and other routine treatments. Patients in control gyoup received routine treatments only. The oxygenation index (Pa02/Fi0=)，extravascular lung water index (EYL,WI)，arterial partial pressure of carbon dioxide (PaC02)，heart rate (HR)，mean arterial pressure (MAP) were compared between control group and treatment group before and 6，24, 48， 72 hours after treatment. The duration of mechanical ventilation (M}).ICL stay time，percentage of weaning from MV， and 28-day survival rate were also compared. Results The indexes of pulmonary function were improved aftertreatment in both groups. With prolonged time of treatment, Pa02/Fi02 (mm Hg, 1 mm Hg=0.133 kPa) was elevated， and EVLWI }ml/kg}，PaCO- }mm Hg} were lowered，and the improvements were more marked in treatment group compared with control group (6-hour Pa0_/FiOZ: 92.6土7.2 vs. 83.8士11.4, 24-hour EVLWI:10.8士3.7 vs. 12.6士 4.5，24-hour PaCO=: 47.2士8.5 vs. 51.4士4.8，all P。