连续血液净化治疗尿毒症合并急性呼吸窘迫综合征的临床研究  

Clinical study of continuous renal replacement therapy in uremia patient with acute respiratory distress syndrome

作　　者：罗敏[1] 刘易林[1] 李莉[1] 焦志勇[2] LUO Min;LIU Yi-lin;LI Li;JIAO Zhi-yong(Department of Critical Care Medicine,Yuebei People’s Hospital;Department of Gastroenterology,Yuebei People’s Hospital,Shaoguan,Guangdong 512000)

机构地区：[1]粤北人民医院重症医学科 [2]粤北人民医院消化内科,广东韶关512000

出　　处：《赣南医学院学报》2021年第3期280-283,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:研究连续性血液净化对尿毒症合并急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)的临床疗效。方法:选择本院2016年5月至2019年5月收治的尿毒症合并ARDS患者42例为研究对象,根据治疗方案的不同分为对照组(21例)和处理组(21例);对照组采用常规透析+内科治疗,处理组采用连续肾脏替代(Continuous Renal Replacement Therapy,CRRT)+内科治疗。比较两组患者治疗前和治疗后24 h急性生理学及慢性健康评分系统Ⅱ(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭评估(Sequential organ failure assessment,SOFA)评分、炎症指标(PCT、CRP)、血流动力学改变[心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)]、生化指标[血钾离子(血K^(+))、血尿素氮(血BUN)、血肌酐(血Cr)]、氧合指数及入院28 d预后情况。结果:治疗后,两组患者APACHEⅡ评分、SOFA评分、HR、PCT、CRP、血K^(+)、血BUN、血Cr指标均低于本组治疗前,CVP、MAP、氧合指数均高于本组治疗前,差异均有统计学意义(P<0.05)。且处理组患者的APACHEⅡ评分、SOFA评分、HR、PCT、CRP、血K^(+)、血BUN、血Cr水平低于对照组,CVP、MAP、氧合指数水平高于对照组,处理组患者入院28 d死亡率为19.05%(4/21),低于对照组52.38%(11/21),差异均有统计学意义(P<0.05)。结论:连续性血液净化对尿毒症合并ARDS患者的治疗效果良好,提高生存率,有效改善患者的生命质量。Objective:To explore the therapeutic value of continuous renal replacement therapy(CRRT)in uremia patient with acute respiratory distress syndrome(ARDS).Methods:A total of 42 cases of uremic ARDS patients admitted to our hospital from May 2016 to May 2019 were selected for this research.According to different treatment strategies,they were divided into control group(21 cases)and experimental group(21 cases).Routine treatment was used in the con⁃trol group,while routine treatment and continuous renal replacement therapy(CRRT)were used in the experimental group to compare the APACHEⅡscore,SOFA score,inflammatory index(PCT,CRP),haemodynamics(HR,CVP and MAP),biochemical index(K^(+),BUN and Cr),oxygenation index and the prognosis at 28 days after admission.Results:After treatment,APACHEⅡscore,SOFA score,HR,PCT,CRP,K^(+),BUN and Cr in the two groups were all lower than before,meanwhile,CVP,MAP and oxygenation index were all higher than those before treatment,the differences were statisticaly significant(P<0.05).In addition,APACHEⅡscore,SOFA score,HR,PCT,CRP,K^(+),BUN and Cr of the observation group were lower than those of the control group,what’s more,the levels of CVP,MAP and oxygenation index were higher than that of the control group,the mortality rate of the observation group on the 28th day of admission was 19.05%,lower than 52.38%of the control group,the differences were statisticaly significant(P<0.05).Conclusion:CRRT has good therapeutic strategy for the uremia patient with ARDS,and can improve the quality of life of patients.It is worthy of clinical promotion.

关 键 词：连续性血液净化 尿毒症 呼吸窘迫综合征 成人 

分 类 号：R56[医药卫生—呼吸系统]