乌司他丁联合持续血液净化治疗对急性呼吸窘迫综合征患者肺血管内皮通透性的影响研究  

Influence of Continuous Blood Purification Combined with Ulinastatin on Pulmonary Vascular Endothelium Permeability for Patients with ARDS

作　　者：季明霞[1] 斯小水[1] 何建新[1] 刘宏革[1] 陈梦燕[1] 王娇[1] 黄静[1] 郑文娟[1] 朱黎君 王俊峰[1] 

机构地区：[1]浙江省义乌市中心医院,322000

出　　处：《中国全科医学》2015年第6期688-691,共4页Chinese General Practice

基　　金：义乌市科研计划项目(13-3-30);义乌市医学重点学科建设资助(13-ZD03)

摘　　要：目的探讨乌司他丁联合持续血液净化治疗对急性呼吸窘迫综合征(ARDS)患者肺血管内皮通透性的影响。方法选取2013年1月—2014年7月入住义乌市中心医院ICU的ARDS患者80例,按照入院先后顺序进行分组,对照组20例、A组20例、B组20例、C组20例。对照组予以常规综合治疗,A组在常规综合治疗基础上加用乌司他丁,B组加用持续血液净化治疗,C组加用乌司他丁+持续血液净化治疗。分别观察各组治疗前后血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)、氧合指数(Pa O2/Fi O2)、平均动脉压(MAP)、中心静脉压(CVP)的变化及机械通气时间、住ICU时间。结果治疗前,4组患者EVLWI、PVPI、Pa O2/Fi O2、MAP及CVP比较,差异均无统计学意义(P>0.05)。治疗后,A组、B组、C组EVLWI、PVPI较对照组降低,Pa O2/Fi O2较对照组升高(P<0.05);C组EVLWI、PVPI较A组、B组降低,Pa O2/Fi O2较A组、B组升高(P<0.05);A组与B组EVLWI、PVPI、Pa O2/Fi O2比较,差异均无统计学意义(P>0.05);B组、C组MAP、CVP较对照组、A组降低(P<0.05);对照组与A组、B组与C组MAP、CVP比较,差异均无统计学意义(P>0.05)。A组、B组、C组机械通气时间及住ICU时间较对照组缩短(P<0.05);C组机械通气时间及住ICU时间较A组、B组缩短(P<0.05);A组与B组比较,差异无统计学意义(P>0.05)。结论乌司他丁联合持续血液净化治疗能发挥各自的优点,显著改善ARDS患者的肺血管通透性,同时又能很好地维持血流动力学的稳定,最终提高临床疗效。Objective To investigate the influence of continuous blood purification combined with Ulinastatin on pulmonary vascular endothelium permeability for patients with acute respiratory distress syndrome（ ARDS）. Methods Eighty ARDS patients who were admitted to the ICU of the Central Hospital of Yiwu from January 2013 to July 2014 were randomly divided into control group, group A, group B and group C, with each group 20 cases. The control group was given routine comprehensive treatment,the group A was given additional Ulinastatin based on routine comprehensive treatment,the group B was given continuous blood purification,and the group C was given Ulinastatin combined with continuous blood purification. The changes of extravascular lung water index（ EVLWI）, pulmonary vascular permeability index（ PVPI）, oxygenation index（ Pa O2/ Fi O2）,mean arterial pressure（ MAP） and central venous pressure（ CVP） before and after treatment in each group,and their influence on the duration of ventilatory support and hospital stay in ICU were observed. Results The EVLWI,PVPI,Pa O2/ Fi O2,MAP and CVP showed no statistically significant difference before treatment（ P〉 0. 05）. After treatment,compared with the control group, the EVLWI and PVPI in the groups A, B and C were significantly decreased, but the Pa O2/ Fi O2 was significantly increased（ P〈 0. 05）; compared with the group A and group B,the EVLWI and PVPI in the groupC were significantly decreased,but the Pa O2/ Fi O2 was significantly increased（ P〈 0. 05）; the group A and group B showed no statistically significant difference in EVLWI,PVPI and Pa O2/ Fi O2（ P〉0. 05）. After treatment,compared with the control group and group A,the MAP and CVP in the group B and group C were significantly decreased（ P〈 0. 05）; the control group and group A,the group B and group C showed no statistically significant difference in MAP and CVP respectively（ P〈 0. 05）.Compared with the control group,the groups A,B and C had shorter duration of v

关 键 词：呼吸窘迫综合征 成人 乌司他丁 肺血管通透性 持续血液净化治疗 血管外肺水 中心静脉压 

分 类 号：R563.8[医药卫生—呼吸系统]