持续性血液滤过在脓毒性休克并急性呼吸窘迫综合征患者中的应用

发布时间：2018-03-23 19:21

本文选题：持续性血液滤过　切入点：脓毒性休克　出处：《广东医学》2017年21期

【摘要】：目的探讨持续性血液滤过(CVVH)在脓毒性休克并急性呼吸窘迫综合征(ARDS)患者中的应用及对预后的影响。方法采用回顾性分析方法,选择发病时间24 h的脓毒性休克并ARDS患者65例。每位患者均按照最新的脓毒性休克指南给予标准化治疗。根据是否给予CVVH分为CVVH组(n=28)和非CVVH组(n=37)。分别于治疗后的0、24、48及72 h收集ARDS相关参数、血流动力学参数及各项实验室指标等资料。比较两组患者疾病预后有无差异,并观察患者28 d生存率。结果两组患者治疗后ARDS相关参数、血流动力学参数及各项实验室指标较治疗前均有改善。与非CVVH组比较,CVVH组患者治疗后24 h Pa O2/FIO2增高、血乳酸(LAC)下降及日液体平衡量减少,差异均有统计学意义(P0.05),其余参数差异均无统计学意义(P0.05);治疗后48、72 h ARDS相关参数呼吸末正压(PEEP)、毛细血管渗漏指数(CLI)、血管外肺水(EVLWI)及血流动力学参数去甲肾上腺素用量(NE)、外周血管阻力指数(SVRI)、心指数(CI)改善,差异均有统计学意义(P0.05)。两组呼吸机通气时间比较差异有统计学意义(P0.05)。CVVH组和非CVVH组患者28 d生存率比较差异无统计学意义[71.4%(20/28)vs 67.6%(25/37),χ~2=0.405,P=0.524]。结论 CVVH可以改善脓毒性休克并ARDS患者呼吸功能、稳定血流动力学及缩短呼吸机通气时间,但不改善28 d生存率。
[Abstract]:Objective to investigate the application of CVVH in patients with septic shock and acute respiratory distress syndrome (ARDS) and its influence on prognosis. A total of 65 patients with septic shock associated with ARDS were selected for 24 hours. Each patient was given standardized treatment according to the latest guidelines for septic shock. According to whether or not CVVH was given, the patients were divided into CVVH group (n = 28) and non-#en3# group (n = 37). The ARDS parameters were collected for 48 and 72 hours. Hemodynamic parameters and laboratory parameters were compared between the two groups, and the survival rate of 28 days was observed. Results the ARDS related parameters after treatment were observed in the two groups. Compared with the control group, the hemodynamic parameters and the laboratory parameters were improved. Compared with the non-CVVH group, the PA O2/FIO2 increased, the lactate lactate level decreased and the daily fluid balance decreased in the CVVH group. All the differences were statistically significant (P 0.05) and no significant difference in other parameters (P 0.05). Positive end-respiratory pressure (PEEPN), capillary leakage index (CLI), extravascular pulmonary water (EVLWI) and hemodynamic parameters (norepinephrine) were observed in 48 hours after treatment. The peripheral vascular resistance index (SVRI) and the cardiac index (CI) were improved. There was significant difference in ventilator ventilation time between the two groups. There was no significant difference in 28 day survival rate between the two groups. Conclusion CVVH can improve respiratory function in patients with septic shock and ARDS. Hemodynamics was stabilized and ventilator time was shortened, but 28 day survival rate was not improved.
【作者单位】：海南医学院第二附属医院东湖分院急诊科;
【基金】：海南省医学科研课题(编号:琼卫2013资助-025号)
【分类号】：R459.7;R563.8

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