连续性血液净化在小儿急性肺损伤/急性呼吸窘迫综合征治疗中的应用研究  

Efficacy of Continuous Blood Purification in Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome

作　　者：张英谦[1] 郝京霞[1] 黄波[1] 杨娟[1] 朱孟沙[1] 李丽景[1] 张贵英[1] 

机构地区：[1]河北省儿童医院重症监护科,河北省石家庄市050031

出　　处：《中国全科医学》2012年第30期3476-3480,共5页Chinese General Practice

基　　金：河北省科技支撑计划项目(10276105D-14)

摘　　要：目的探讨连续性血液净化(CBP)对小儿急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的临床疗效及其对预后的影响。方法选取2010年4月—2012年6月收住我院儿科重症监护病房(PICU)的低氧血症患儿60例为研究对象,根据氧合指数(PaO2/FiO2)分为ALI组30例和ARDS组30例,进一步采用随机数字表法分为对照1组(常规综合治疗ALI组)15例,试验1组(CBP治疗ALI组)15例;对照2组(常规综合治疗ARDS组)15例,试验2组(CBP治疗ARDS组)15例。记录各组不同时间点(0 h、24 h、48 h)的PaO2/FiO2、静态肺顺应性、呼吸道阻力,抽取静脉血检测肝肾功能、心肌酶、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、血乳酸水平,同时记录患儿的呼吸机撤离时间、低氧纠正时间,计算病死率。结果试验1组患儿48 h静态肺顺应性较对照1组明显升高,差异有统计学意义(P<0.05);试验1组患儿静态肺顺应性48 h时较0 h、24 h时均明显升高,差异有统计学意义(P<0.05)。对照2组与试验2组患儿0 h、24 h、48 h PaO2/FiO2、静态肺顺应性、气道阻力组间比较,差异均无统计学意义(P>0.05);对照2组和试验2组患儿不同时间点PaO2/FiO2、静态肺顺应性、气道阻力组内比较,差异均无统计学意义(P>0.05)。对照1组与试验1组患儿24 h、48 h谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿素氮(BUN)比较,差异均有统计学意义(P<0.05);对照1组患儿AST 24 h、48 h与0 h,BUN 48 h与0 h比较,差异均有统计学意义(P<0.05);试验1组患儿ALT 24 h、48 h与0 h,血肌酐(Scr)24 h、48 h与0 h,BUN 24 h、48 h与0 h,AST 24 h、48 h与0 h,CRP 48 h与0 h、24 h比较,差异均有统计学意义(P<0.05)。对照2组与试验2组患儿48 h AST比较,差异有统计学意义(P<0.05);对照2组患儿CRP 24 h与0 h、48 h与0 h、48 h与24 h比较,差异均有统计学意义(P<0.05);试验2组患儿AST 24 h与0 h、48 h与0 h、48 h与24 h,TNF-α48 h与0 h、24h,CRP 24 h与0 h、48 h与0 h、48 h与24 h,血Objective To investigate the clinical efficacy of Continuous Blood Purification （CBP） in patients with acute lung injury （ALI） and acute respiratory distress syndrome （ARDS） and its influence on prognosis. Methods 60 hypoxemia children admitted to the pediatric intensive care unit of our hospital from April 2010 to June 2012 were divided into ALI group and ARDS group according to PaO2FiO2 with each group 30 cases. And the two groups were further randomly divided into control 1 group, experiment 1 group, control 2 group and experiment 2 group, with each group 15 cases. The PaOJFiO2 , static lung compliance, airway resistance, liver and kidney function tested by venous blood, myocardial enzyme, TNF -α, CRP and blood lactate were recorded at 0 h, 24 h and 48 h, meanwhile, withdraw time of breathing machine and time to correct hypoxemia were recorded and the mortality rate was calculated. Results The static lung compliance was significantly increased at 48 h in experiment 1 group compared with that in control 1 group （ P 〈 0. 05 ） . In experiment 1 group, the static lung compliance at 48 h was significantly increased compared with that at 0 h and 24 h （ P 〈 0.05 ） . The PaO2/FiO2, static lung compliance and airway resistance at 0 h, 24 h and 48 h showed no statistically significant differences between control 2 group and experiment 2 group （P 〉 0. 05 ） . The differences of PaOE/FiO2 , static lung compliance and airway resistance at different time within control 2 group and experiment 2 group showed no statistically significant differences （ P 〉 0.05 ） . The ALT, AST and BUN at 24 h and 48 h between control 1 group and experiment 1 group showed statistically significant differences （ P 〈 0.05 ） . In control 1 group, the AST at 24 h and 48 h and the BUN at 48 h showed statistically significant differences compared with AST at 0h and BUN at 0h （ P 〈 0.05 ） . In experiment 1 group, the ALT at 24 h and 48 h, the AST at 24 h and 48 h, the Ser at 24 h and 48 h, the BUN at 24

关 键 词：连续性血液净化 急性肺损伤 急性呼吸窘迫综合征 

分 类 号：R725.638[医药卫生—儿科]