亚低温对重症急性呼吸窘迫综合征患者氧代谢的影响  

Effect of mild hypothermia on oxygen metabolism in patients with severe acute respiratory distress syndrome

作　　者：冼海涛[1] 曾晖[1] 蔡立华[1] 覃炳军[1] 安曙光[1] 李盘石[1] 范彦琦[1] 何瑞玲[1] 

机构地区：[1]东莞市人民医院,广东东莞523000

出　　处：《山东医药》2016年第2期14-16,共3页Shandong Medical Journal

基　　金：广东省医学科研基金立项课题(A2013835)

摘　　要：目的探讨亚低温对重症急性呼吸窘迫综合征（ARDS）患者氧代谢的影响。方法将24例重症ARDS患者随机分为对照组和亚低温组各12例,对照组给予常规治疗,亚低温组在此基础上加用亚低温干预,使用降温毯维持肛温33~35℃。比较两组治疗前及治疗24、48、72 h的血流动力学指标[心率（HR）、平均动脉压（MAP）、平均肺动脉压（MPAP）、心脏指数（CI）]以及全身氧代谢指标[血乳酸（LA）、氧合指数（PaO_2/FiO_2）、氧输送（DO_2）、氧消耗（VO_2）、氧摄取率（O_2ER）]。结果亚低温组治疗后24、48、72 h的HR、MAP、CI均较治疗前降低（P均〈0.05）;亚低温组24、48、72 h的HR、MAP、MPAP较对照组降低,48、72 h的CI较对照组降低（P均〈0.05）。亚低温组24、48、72 h的PaO_2/FiO_2较治疗前升高,VO_2、O_2ER于48、72 h增加,DO2于72 h减少（P均〈0.05）;亚低温组LA于48、72 h较对照组下降（P均〈0.05）。结论亚低温能改善氧合功能,可能通过改善细胞利用氧功能,维持机体氧供需平衡,且对循环影响少。Objective To explore the effects of mile hypothermia on oxygen metabolism of patients with severe acute respiratory distress syndrome（ ARDS）. Methods Twenty-four patients with severe ARDS were randomly divided into two groups,12 in each group： the control group and mild hypothermia group. Both groups were treated in accordance with guidelines. In the mild hypothermia group,mile hypothermia intervention was added. The rectal temperature was controlled in 33-35 ℃. The haemodynamics indexes including heart rate（ HR）,mean arterial pressure（ MAP）,mean pulmonary arterial pressure（ MPAP） and cardiac index（ CI）,and metabolic indexes including blood lactic acid（ LA）,oxygenation index（ PaO_2/ FiO_2）,oxygen consumption（ VO_2）,oxygen delivery（ DO_2） and oxygenuptake rate（ O_2ER） before treamtnent and 24 h,48 h and 72 h after treatment between the two groups were compared. Results After treatment with hypothermia,HR,MAP and CI at 24 h,48 h and 72 h were lower than that before treatment in the mild hypothermia group（ all P〈0. 05）. Compared with the control group,HR,MAP,MPAP of 24 h,48 h,72 h in the mild hypothermia group were lower,CI at 48 h and 72 h was decreased as compared with that of the control group（ all P〈0. 05）. Pa O2/ Fi O2 at 24 h,48 h and 72 h after treatment were increased as compared with those before treatment,VO_2 and O_2ER were increased at 48 h and 72 h while DO_2 was decreased at 72 h in the mild hypothermia group（ all P〈0. 05）. Compared with the control group,LA in the mild hypothermia group at 48 h and 72 h were decreased（ all P〈0. 05）. Conclusion Mild hypothermia could improve oxygenation function probably through improving the cell function of oxygen use,maintaining the oxygen balance of human body and reducing the influence on the circulatory system.

关 键 词：急性呼吸窘迫综合征 亚低温 氧代谢 

分 类 号：R563.8[医药卫生—呼吸系统]