高容量血液滤过对急性呼吸窘迫综合征患者炎性介质及氧代谢的影响

发布时间：2019-08-05 13:58

【摘要】：目的探讨高容量血液滤过(HVHF)对急性呼吸窘迫综合征(ARDS)患者炎性介质及氧代谢的影响。方法将72例ARDS患者分为HVHF组(36例)和对照组(36例),两组的常规治疗方法相同,HVHF组在常规治疗的基础上给予HVHF治疗。比较两组患者治疗前及治疗72 h后炎性介质、氧代谢指标及生命体征的变化,并记录两组患者的机械通气时间、ICU住院时间及4周内病死率。结果治疗前两组患者的炎性介质(TNF-α、IL-1、IL-6、hs-CRP、PCT)、氧代谢指标(Pv O2、Pa O2/Fi O2、VO2、DO2)及生命体征(HR、MAP、APACHEⅡ评分、MODS评分)比较差异无统计学意义(均P0.05),具有可比性;治疗72 h后两组患者的炎性介质(TNF-α、IL-1、IL-6、hs-CRP、PCT)、氧代谢指标(Pv O2、Pa O2/Fi O2、VO2、DO2)及生命体征(HR、MAP、APACHEⅡ评分、MODS评分)均较治疗前有显著改善(P0.05,P0.01),而HVHF组患者较对照组改善更显著(P0.01);HVHF组患者的机械通气时间、ICU住院时间明显短于对照组(t=2.588 8、2.581 8,均P0.05),4周内病死率明显低于对照组(醊2=4.430 7,P0.05)。结论 HVHF治疗能更有效地改善ARDS患者的氧代谢和生命体征,降低APACHEⅡ评分、MODS评分,缩短机械通气时间和ICU住院时间,降低4周内病死率,其机制可能与更有效地清除体内炎症介质有关。
[Abstract]:Objective to investigate the effect of hypervolemic hemofiltration (HVHF) on inflammatory mediators and oxygen metabolism in patients with acute respiratory distress syndrome (ARDS). Methods 72 patients with ARDS were divided into HVHF group (n = 36) and control group (n = 36). The routine treatment methods of the two groups were the same. HVHF group was treated with HVHF on the basis of routine treatment. The changes of inflammatory mediators, oxygen metabolism indexes and vital signs were compared between the two groups before and 72 hours after treatment, and the mechanical ventilation time, hospitalization time of ICU and mortality within 4 weeks were recorded. Results there were no significant differences in inflammatory mediators (TNF- 伪, IL-1,IL-6,hs-CRP,PCT), oxygen metabolism indexes (Pv O 2, Pa O2/Fi O 2, VO 2, do 2) and vital signs (HR,MAP, Apache 鈪，

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