体外二氧化碳清除联合连续性肾脏替代治疗对急性呼吸窘迫综合征患者膈肌功能的影响  

Impact of extracorporeal carbon dioxide removal combined with continuous renal replacement therapy on diaphragmatic function in patients with acute respiratory distress syndrome

作　　者：忽新刚 张文稳 蒋亚芬 张杰 刘智达 田翠杰 王学林 程剑剑 Hu Xingang;Zhang Wenwen;Jiang Yafen;Zhang Jie;Liu Zhida;Tian Cuijie;Wang Xuelin;Cheng Jianjian(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,Henan,China;Department of Public Utilities Development,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省人民医院,郑州大学人民医院呼吸与危重症医学科,郑州450003 [2]河南省人民医院,郑州大学人民医院公共事业发展部,郑州450003

出　　处：《中华危重病急救医学》2024年第2期147-151,共5页Chinese Critical Care Medicine

基　　金：河南省科技发展计划项目(212400410060)。

摘　　要：目的探讨体外二氧化碳清除(ECCO_(2)R)联合连续性肾脏替代治疗(CRRT)对接受机械通气的急性呼吸窘迫综合征(ARDS)患者呼吸效率和膈肌功能的影响。方法采用前瞻性随机对照研究方法,纳入2019年1月至2021年1月河南省人民医院呼吸与危重症医学科收治的60例轻中度ARDS患者,并按随机数字表法分为观察组和对照组,每组30例。所有患者均给予抗感染、抗炎、机械通气等治疗,在此基础上,观察组给予ECCO_(2)R联合CRRT治疗,对照组给予床旁CRRT治疗。记录患者性别、年龄、病因、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等一般资料;分别于治疗12 h和24 h进行血气分析〔动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))〕,记录呼吸力学参数〔包括潮气量、呼吸频率、最大呼气压(MEP)和最大吸气压(MIP)〕并计算浅快呼吸指数(RSBI),用酶联免疫吸附试验(ELISA)检测血清中谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)和超氧化物歧化酶(SOD)水平;治疗24 h超声测量膈肌活动度及膈肌厚度。结果两组患者年龄、性别、病因、APACHEⅡ评分比较差异均无统计学意义,说明两组基线资料均衡可比。与本组12 h比较,观察组治疗24 h PaO_(2)、PaO_(2)/FiO_(2)明显升高,PaCO_(2)明显下降,RSBI明显下降,MEP、MIP明显升高,血清GSH-Px、MDA明显下降,SOD明显升高;对照组仅PaCO_(2)明显下降。观察组治疗12 h和24 h时PaCO_(2)较对照组明显下降〔mmHg(1 mmHg≈0.133 kPa):55.05±7.57比59.49±6.95,52.77±7.88比58.25±6.92,均P<0.05〕,但PaO_(2)、PaO_(2)/FiO_(2)与对照组比较差异均无统计学意义。与对照组比较,观察组治疗12 h和24 h RSBI显著下降(次·min-1·L-1:85.92±8.83比90.38±3.78,75.73±3.86比90.05±3.66,均P<0.05),MEP、MIP明显升高〔MEP(mmH2O,1 mmH2O≈0.01 kPa):86.64±5.99比83.88±4.18,93.70±5.59比85.04±3.73;MIP(mmH2O):44.19±6.66比41.17±3.13,57.52±5.28比42.34Objective To investigate the effects of extracorporeal carbon dioxide removal(ECCO_(2)R)combined with continuous renal replacement therapy(CRRT)on respiratory efficiency and diaphragm function in patients with acute respiratory distress syndrome(ARDS)received mechanical ventilation.Methods A prospective randomized controlled study was conducted.Sixty patients with mild to moderate ARDS admitted to the department of respiratory and critical care medicine of Henan Provincial People's Hospital from January 2019 to January 2021 were enrolled,and they were divided into observation group and control group according to the random number table method,with 30 cases in each group.All patients received antibiotics,anti-inflammatory,and mechanical ventilation therapy.On this basis,the observation group received ECCO_(2)R and CRRT,while the control group received bedside CRRT.Baseline data including gender,age,etiology,acute physiology and chronic health evaluationⅡ(APACHEⅡ),etc.,were recorded.Arterial blood gas analysis[including arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),and oxygenation index(PaO_(2)/FiO_(2))]was performed at 12 hours and 24 hours during the treatment,and respiratory mechanics parameters[including tidal volume,respiratory rate,maximum expiratory pressure(MEP),and maximum inspiratory pressure(MIP)]were recorded,and rapid shallow breathing index(RSBI)was calculated.The levels of glutathione peroxidase(GSH-Px),malondialdehyde(MDA),and superoxide dismutase(SOD)in serum were detected by enzyme-linked immunosorbent assay(ELISA).Diaphragm thickness and diaphragm activity were measured by ultrasonography at 24 hours during the treatment.Results There were no significantly differences in age,gender,etiology,and APACHEⅡscore between the two groups,indicating that the baseline data of the two groups were balanced and comparable.Compared with the 12 hours after treatment,the PaO_(2) and PaO_(2)/FiO_(2) in the observation group significantly increased,PaCO_(2

关 键 词：体外二氧化碳清除 急性呼吸窘迫综合征 膈肌 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]