组合式血液净化治疗急性呼吸窘迫综合征对患者炎症因子和生物标志物的影响  

Effects of combined blood purification on the inflammatory factors and biomarkers of patients with acute respiratory distress syndrome

作　　者：姚淑雯[1] 许卓谦[1] 利雪燕 李东华[1] 叶家骏[1] 王淑香[1] 郑国营[1] Yao Shuwen;Xu Zhuoqian;Li Xueyan;Li Donghua;Ye Jiajun;Wang Shuxiang;Zheng Guoying(ICU,Huadu District People's Hospital of Guangzhou,Guangzhou 510800,China)

机构地区：[1]广州市花都区人民医院重症医学科,510800

出　　处：《国际医药卫生导报》2021年第10期1485-1488,共4页International Medicine and Health Guidance News

基　　金：广州市花都区科技计划项目(15-HDWS-011)。

摘　　要：目的探讨组合式血液净化[血液灌流(HP)联合脉冲式高容量血液滤过(PHVHF)]治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床疗效。方法选取2015年4月至2017年4月本院ICU住院的58例ARDS患者作为治疗组;同时选取58例同期健康体检者作为对照组。治疗组男32例,女26例,年龄(51.9±17.2)岁;对照组男33例,女25例,年龄(52.7±14.4)岁。治疗组患者以HP+PHVHF治疗。比较ARDS患者治疗前后血气指标、临床指标、炎症因子、生物标志物[血管生成素2、Ⅱ型肺泡细胞表面抗原(KL-6)和蛋白C]的浓度。结果与健康对照组相比,ARDS患者治疗前血氧分压(PaO_(2))、血氧饱和度(SaO_(2))明显降低,动脉血二氧化碳分压(PaCO_(2))明显升高,差异均有统计学意义(均P<0.01);治疗后4 h,治疗组PaO_(2)、SaO_(2)分别为(63.6±16.4)mmHg(1 mmHg=0.133 kPa)、(86.3±6.5)%,均高于治疗前(59.5±17.3)mmHg、(81.8±7.5)%,PaCO_(2)为(51.4±10.7)mmHg,低于治疗前(53.6±15.9)mmHg,差异均有统计学意义(均P<0.01);治疗后8 h、12 h检测发现效果越明显。经组合式血液净化后,ARDS患者的临床症状、炎症因子、血清生物标志物(血管生成素2、KL-6和蛋白C)浓度均有显著改善,差异均有统计学意义(均P<0.01)。结论组合式血液净化治疗ARDS可改善血气指标,有效清除炎症介质,改善肺功能,临床效果显著,值得推广应用。Objective To explore the clinical effect of combined blood purification[hemoperfusion(HP)+pulsed high volume hemofiltration(PHVHF)]in the treatment of acute respiratory distress syndrome(ARDS).Methods From April 2015 to April 2017,58 patients with ARDS treated in ICU of our hospital were enrolled as a treatment group,and 58 healthy contemporaries were enrolled as a control group.There were 32 males and 26 females in the treatment group,with the age of(51.9±17.2)years old;there were 33 males and 25 females in the control group,with the age of(52.7±14.4)years old.The patients in the treatment group were treated by HP+PHVHF.Blood gas indexes,clinical symptoms,inflammatory markers,serum concentrations of biomarkers[angiopoietin-2,Krebs Von den Lungen-6(KL-6),and protein C]were compared between before and after treatment.Results Compared with those in the healthy control group,the levels of blood oxygen partial pressure(PaO_(2))and blood oxygen saturation(SaO_(2))were significantly decreased in ARDS patients before treatment,and the level of arterial blood carbon dioxide partial pressure(PaCO_(2))was significantly increased(all P<0.01);4 h after treatment,the levels of PaO_(2) and SaO_(2) in the treatment group were(63.6±16.4)mmHg(1 mmHg=0.133 kPa)and(86.3±6.5)%,which were higher than those before treatment[(59.5±17.3)mmHg and(81.8±7.5)%],the level of PaCO_(2) was(51.4±10.7)mmHg,which was lower than that before treatment[(53.6±15.9)mmHg](all P<0.01);the results showed that the effects were more obvious 8 h and 12 h after treatment.After combined blood purification,clinical symptoms,inflammatory factors,serum concentrations of biomarkers(angiopoietin-2,KL-6,and protein C)were significantly improved in ARDS patients(all P<0.01).Conclusion Combined blood purification can significantly improve the blood gas indexes,remove inflammatory markers,improve pulmonary function,and has good clinical performance,which deserves to be applied in the future.

关 键 词：组合式血液净化 急性呼吸窘迫综合征 炎症因子 生物标志物 

分 类 号：R563.8[医药卫生—呼吸系统]