急性呼吸窘迫综合征患者血液净化治疗的临床观察
发布时间：2018-01-15 13:19
本文关键词：急性呼吸窘迫综合征患者血液净化治疗的临床观察 出处：《华中科技大学学报(医学版)》2016年06期 论文类型：期刊论文
更多相关文章： 急性呼吸窘迫综合征 连续性血液净化 临床指标 炎性因子
【摘要】：目的探讨连续性血液净化治疗对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的临床作用和治疗时机。方法 ARDS患者96例,按数字随机表法和APPACHEⅡ评分分为A1组和B1组(APPACHEⅡ≥20分),A2组和B2组(15分≤APPACHEⅡ20分),每组24例。A1和A2组患者在给予病因治疗和早期脏器功能支持治疗等常规治疗的基础上给予连续性血液净化治疗,B1和B2组仅给予常规治疗。在连续性血液净化治疗开始及治疗后72h,观察各组患者治疗前后临床生化、危重评分、血浆和超滤液中炎性因子水平、临床指标;监测各组患者血流动力学和呼吸力学参数。结果 1治疗后72h,4组患者心指数(cardiac index,CI)、全心舒张末期容积指数GEDVI、血管外肺水指数(extravascular lung water index,EVLWI)、肺血管通透性(PVPI)和乳酸(LAC)均降低,氧合指数升高,但A1组下降和升高程度更明显(均P0.05)。2治疗后72h,4组患者气道峰压(peak inspiratory pressure,PIP)、气道平台压(plateau pressure,Pplat)、气道平均压(mean airway pressure,MPaw)、有效静态总顺应性(Cst)均降低,但A1组下降程度更明显(均P0.05)。3治疗后72h,4组患者血浆炎性因子如肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)浓度均降低,A1组降低更明显(均P0.05)。4治疗后72h,4组患者APACHEⅡ、MODS、Murray和SIRS评分均降低,但A1组下降程度更明显(均P0.05);治疗2周后,给予连续性血液净化治疗的A1、A2组患者MODS发生率、死亡率、机械通气时间、住ICU时间均低于相对应的常规治疗的B1、B2组,但A1组获益更明显(均P0.05)。结论连续性血液净化治疗能降低炎症因子水平,改善ARDS患者的血流动力学、呼吸力学状况,改善患者预后。
[Abstract]:Objective to investigate the effect of continuous blood purification therapy on acute respiratory distress syndrome (acute respiratory distress syndrome, ARDS) the timing of clinical effects and treatment of patients. Methods 96 cases of ARDS patients were randomly divided into A1 and APPACHE II score group and B1 group (APPACHE II more than 20 cent), A2 group and B2 group (15 < APPACHE II 20), 24 cases in each group and.A1 A2 group were treated with continuous blood purification therapy based on routine treatment given etiological treatment and early organ function support treatment on the B1 and B2 group were only given conventional therapy. Treatment began after treatment and 72h in continuous blood, clinical biochemistry and the critical score before and after treatment in patients with clinical observation indexes in plasma and ultrafiltrate levels of inflammatory cytokines were measured; hemodynamics and respiratory mechanics parameters. Results 1 72h after treatment, 4 groups of patients with cardiac index (cardiac index, CI), heart Shu 寮犳湯鏈熷绉寚鏁癎EDVI,琛，
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