乌司他丁联合连续性血液净化对ARDSexp患者肺毛细血管通透性及呼吸功能的影响分析  

The effect of Urinastatin combined with continuous blood purification on pulmonary capillary permea-bility and respiratory function in patients with extrapulmonary acute respiratory distress syndrome

作　　者：钱志峰 毛发江 徐磊[1] 徐丽萍[1] 王海林[1] 

机构地区：[1]中国人民解放军第454医院ICU,南京210002 [2]上海中医药大学附属市中医医院科研处,上海200071

出　　处：《中国医学前沿杂志（电子版）》2017年第10期90-94,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的观察乌司他丁联合连续性血液净化(continuous blood purification,CBP)对肺外源性急性呼吸窘迫综合征(extrapulmonary acute respiratory distress syndrome,ARDSexp)患者肺毛细血管通透性及呼吸功能的影响,为ARDSexp的治疗提供新的思路。方法选取中国人民解放军第454医院2012年8月至2016年8月收治的158例ARDSexp患者为研究对象。按照治疗方案不同,将接受单一CBP治疗的87例患者纳入血液净化组,将接受乌司他丁联合CBP治疗的71例患者纳入联合治疗组。比较两组患者急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、机械通气时间、ICU住院天数、病死率,治疗前后血气指标、肺毛细血管通透性及呼吸功能变化情况。结果联合治疗组患者治疗后APACHEⅡ评分和病死率均显著低于血液净化组(P<0.05),机械通气时间和ICU住院天数均显著短于血液净化组(P<0.05)。两组患者治疗后肺毛细血管通透指数(pulmonary vascular permeability index,PVPI)和血管外肺水指数(extravascular lung water index,EVLWI)均显著低于治疗前(P<0.05),联合治疗组患者PVPI和EVLWI均显著低于血液净化组(P<0.05)。治疗后两组患者肺泡-动脉血氧分压差[alveolar arterial PO_2 difference(gradient),P(A-a)O_2]、气道峰压(peak inspiratory pressure,PIP)、气道阻力均显著低于治疗前(P<0.05),氧合指数和肺动态顺应性(lung dynamic compliance,Cdyn)均显著高于治疗前(P<0.05);治疗后联合治疗组患者P(A-a)O_2和PIP均显著低于血液净化组(P<0.05),氧合指数和Cdyn均显著高于血液净化组(P<0.05)。结论乌司他丁联合CBP治疗可进一步改善ARDSexp患者的肺毛细血管通透性和呼吸功能,显著提高患者预后质量。Objective To observe the effect of Urinastatin combined with continuous blood purification（CBP） of on pulmonary capillary permeability and respiratory function in patients with extrapulmonary acute respiratory distress syndrome（ARDSexp）, to provide new ideas for the treatment of ARDSexp. Method 158 ARDSexp patients admitted to the 454^（th） Hospital of PLA from August 2012 to August 2016 were selected as the subjects of study. According to the treatment, 87 patients who received single CBP treatment were included in blood purification group, 71 patients who received Urinastatin combined with CBP were included in combined treatment group. The acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score, duration of mechanical ventilation and ICU stay, mortality, the changes of pulmonary capillary permeability and respiratory function, blood gas indexes before and after treatment were compared between the two groups. Result The APACHE Ⅱscore and mortality in combined treatment group were significantly lower than blood purification group（P〈0.05）, and the duration of mechanical ventilation and ICU hospitalization days were significantly shorter than blood purification group（P〈0.05）. After treatment, the pulmonary vascular permeability index（PVPI） and extravascular lung water index（EVLWI） of the two groups were significantly lower than those before treatment（P〈0.05）, the PVPI and EVLWI of combined treatment group were significantly lower than that of blood purification group（P〈0.05）. After treatment, two groups of patients with P（A-a）O_2, peak airway pressure（PIP）, airway resistance were significantly lower than those before treatment（P〈0.05）, PaO_2/FiO_2 and lung dynamic compliance（Cdyn） were significantly higher than those before treatment（P〈0.05）. After treatment, the P（A-a）O_2 and PIP were significantly lower than blood purification group（P〈0.05）, PaO_2/FiO_2 and Cdyn were significantly higher than blood purification group�

关 键 词：乌司他丁 连续性血液净化 肺外源性急性呼吸窘迫综合征 肺毛细血管通透性 呼吸功能 

分 类 号：R563.8[医药卫生—呼吸系统]