连续性血液净化治疗急性呼吸窘迫综合征伴低氧血症的临床疗效  

Efficacy of continuous blood purification in treatment of acute respiratory distress syndrome with hypoxemia

作　　者：肖洋[1] 关卫[1] 丛云峰[1] 马峻峰[1] 张维亮[1] 

机构地区：[1]黑龙江省医院南岗院区重症医学科,黑龙江哈尔滨150001

出　　处：《中国校医》2014年第12期955-957,共3页Chinese Journal of School Doctor

基　　金：黑龙江省卫生厅科研项目(2004-057)

摘　　要：目的探讨连续性血液净化(CBP)治疗急性呼吸窘迫综合征(ARDS)伴低氧血症的临床效果。方法本院2005年3月—2014年3月共收治ARDS伴低氧血症患者79例,采用随机分层分组法将79例患者分为2组,对照组给予常规综合治疗措施,观察组在综合治疗基础上给予CBP疗法,观察2组治疗前后血流动力学参数、血氧饱和度(Sa O2)、氧合指数(Pa O2/Fi O2)、静态肺顺应性、气道阻力及实验室检测指标。结果 2组心率(HR)及心脏指数(CI)差异无统计学意义(P>0.05),而观察组心输出量(CO)、肺动脉压(PAP)、Sa O2及平均动脉压(MAP)明显优于对照组,2组差异有统计学意义(P<0.05)。治疗48 h后2组Pa O2/Fi O2、静态肺顺应性及气道阻力均优于治疗前(P<0.05),而2组间静态肺顺应性及气道阻力差异无统计学意义(P>0.05。观察组治疗后肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及血乳酸水平均低于对照组,2组差异有统计学意义(P<0.05)。结论CBP疗法能显著改善ARDS伴低血氧症患者的心输出量、血氧饱和度及Pa O2/Fi O2,降低血清炎性因子水平,改善呼吸力学和脏器功能,快速缓解ARDS患者缺氧症状,有利于患者早期康复。Objective To explore the efficacy of continuous blood purification（ CBP） in the treatment of acute respiratory distress syndrome with hypoxemia. Methods According to a stratified randomization method,79 patients with acute respiratory distress syndrome with hypoxemia were divided into a control group and an observation group,and the patients in the control group received the routine therapy and the patients in the observation group received the routine therapy and CBP. The hemodynamic parameters,Sa O2,Pa O2/ Fi O2,static lung compliance,raw and laboratory indexes were observed.Results After the treatment,there were no significant differences between the two groups in HR and CI（ P〈0. 05）,however,the observation group was significantly better than the control group in CO,PAP,Sa O2 and MAP（ P〈0. 05）. After the treatment,Pa O2/ Fi O2,static lung compliance and airway resistance were significantly better than before the treatment in both groups（ P〈0. 05）,however,there were no significant differences between the two groups in static lung compliance and airway resistance（ P〉0. 05）. CRP,TNF-α and the blood lactate in the observation group was significantly lower than those in the control group,and there were significant differences between the two groups（ P〈0. 05）. Conclusions the CBP therapy can significantly improve the cardiac output,Sa O2 and Pa O2/ Fi O2,and not only reduces the serum level of inflammatory factors,but also improves the respiratory mechanics and organ function.

关 键 词：呼吸窘迫综合征 成年人/治疗 缺氧/治疗 血液透析滤过/方法 治疗结果 

分 类 号：R563.8[医药卫生—呼吸系统]