血液灌流联合高容量血液滤过治疗急性呼吸窘迫综合征的临床研究

发布时间：2018-06-04 16:36

  本文选题：血液灌流 + 高容量血液滤过　； 参考：《天津医科大学》2013年硕士论文

【摘要】：急性呼吸窘迫综合征(ARDS)是一种以进行性呼吸困难和顽固性低氧血症为特征的急性呼吸衰竭,病死率高。此病大多由于直接或间接的肺损伤而产生失控的系统性炎症反应。研究表明,细胞因子和炎症介质在ARDS局部炎症的发生、发展和全身炎症反应中起着重要的作用。目前用机械通气治疗以及保护性肺通气策略的提出虽提高ARDS患者的抢救成功率,但尚无有效方法中止ARDS的炎症性肺损伤,使得ARDS的病死率居高不下。本研究着重探讨血液灌流(HP)联合高容量血液滤过(HVHF)对ARDS患者呼吸功能和预后的影响。 目的观察血液灌流联合高容量血液滤过对急性呼吸窘迫综合征(Acute Respiratory Distress Syndrome, ARDS)患者呼吸功能和预后的影响。 方法按随机原则将急性呼吸窘迫综合征患者分为常规对照组(HVHF)20例,血液灌流联合高容量血液滤过组(HP+HVHF)20例。两组患者按中华医学会重症医学分会急性肺损伤／急性呼吸窘迫综合征诊断和治疗指南常规治疗及高容量血液滤过治疗,HP+HVHF组同时进行血液灌流治疗。分别于治疗前及治疗24小时、72小时行动脉血气分析、血清炎症介质、检测气道峰压、肺顺应性,并观察患者重症监护病房(ICU)住院时间、机械通气时间及28天病死率。 结果血液灌流联合高容量血液滤过(HP+HVHF)组患者及机械通气时间(d)及高容量血液滤过治疗(HVHF)时间(d)均明显短于对照组(7.50±4.51比13.00±7.57；6.65±4.48比8.85±4.25,均P0.05)；治疗72小时后,两组急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分(分)均明显下降,且治疗组(HP+HVHF治疗)下降程度优于对照组(15.75±4.96比18.95±7.01,P0.05)：呼吸指数和氧合指数在72小时后治疗组较对照组有显著性差异(3.09±0.49比3.44±0.45；242.95±55.58比179.90±65.31,P0.05)。治疗组24小时和72小时气道峰压、肺顺应性均较治疗前有明显改善(P0.05)。对照组在治疗72小时后气道峰压、肺顺应性均较治疗前改善P0.05。在治疗24小时和72小时后,治疗组TNF-a、IL-6和IL-8三种细胞因子下降水平均较对照组有显著性差异(均P0.05)。治疗组内中,72小时后TNF-a、IL-6和IL-8三种细胞因子较24小时下降明显且有显著性差异(26.30±8.27比18.66±5.21；30.70±10.47比16.04±4.92：29.27±9.03比20.45±6.96,均P0.05) 结论血液灌流联合高容量血液滤过在ARDS的急性期显著降低了影响肺功能的细胞因子的峰值浓度,减轻病情的严重程度,改善预后。
[Abstract]:Acute respiratory distress syndrome (ARDS) is an acute respiratory failure characterized by progressive dyspnea and intractable hypoxemia. This disease is mostly due to direct or indirect lung injury and produce uncontrolled systemic inflammatory response. Studies have shown that cytokines and inflammatory mediators play an important role in the occurrence, development and systemic inflammation of ARDS. Although the treatment of mechanical ventilation and the strategy of protective lung ventilation can improve the rescue success rate of patients with ARDS, there is no effective method to stop the inflammatory lung injury of ARDS, which makes the death rate of ARDS remain high. The purpose of this study was to investigate the effects of hemoperfusion (HPP) combined with high volume hemofiltration (HVHF) on respiratory function and prognosis in patients with ARDS. Objective to observe the effects of hemoperfusion combined with high volume hemofiltration on respiratory function and prognosis in acute Respiratory Distress Syndrome, ARDS) patients with acute respiratory distress syndrome (ARDS). Methods the patients with acute respiratory distress syndrome were randomly divided into control group (n = 20) and hemoperfusion combined with high volume hemofiltration group (n = 20) with HP HVHF)20. According to the guidelines for diagnosis and treatment of acute lung injury / acute respiratory distress syndrome (ARDS) of the Chinese Medical Association, the two groups were treated with hemoperfusion at the same time as the HP HVHF group and the HP HVHF group with high volume hemofiltration therapy. Arterial blood gas analysis, serum inflammatory mediators, peak airway pressure, lung compliance, hospitalization time, mechanical ventilation time and fatality rate of 28 days were observed before treatment and 24 hours and 72 hours after treatment, respectively. Results the time of hypervolemic hemoperfusion combined with hypervolemic hemofiltration HP HVHFs and the time of mechanical ventilation and hypervolemic hemofiltration therapy were significantly shorter than those of the control group (7.50 卤4.51 vs 13.00 卤7.57 卤6.65 卤4.48 vs 8.85 卤4.25, respectively, P0.055.After 72 hours of treatment, the time of hypervolemic hemofiltration was 7.50 卤4.51 vs 8.85 卤4.25, P < 0.05). The scores of acute physiology and chronic health status 鈪，

本文编号：1978064