血浆置换联合连续性静脉-静脉血液滤过对急性呼吸窘迫综合征治疗临床观察.docVIP

血浆置换联合连续性静脉-静脉血液滤过对急性呼吸窘迫综合征治疗临床观察【摘要】 目的 研究血浆置换(PE)联合连续性静脉-静脉血液滤过(CVVH)治疗急性呼吸窘迫综合征(ARDS)的疗效。方法 20例急性呼吸窘迫综合征患者除经内科常规治疗外,行PE联合CVVH)，连续测定心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2),氧合指数(PaO2 /FiO2)、肺动态顺应性(Cdyn)、气道阻力(Raw)，同时抽取静脉血2 ml测定血液C反应蛋白(CRP)的浓度。并进行ICU监护的结果记录以APACHE II评分及SIRS评分判断患者病情的变化。结果 在治疗过程中,血流动力学稳定,血浆置换前后及CVVH治疗前与治疗后相比HR、MAP、CVP,pH、PaO2、PaCO2,其中脉血PaO2、动脉血FiO2、Cdyn、明显升高，Raw明显下降(P0．05)，血浆置换后C反应蛋白(CRP)的浓度明显下降(P0．05),CVVH治疗前与治疗后相比APACHE II评分及SIRS评分差异有统计学意义(P0．05)。结论 PE联合CVVH治疗可显著改善急性呼吸窘迫综合征患者的临床症状,有效改善急性呼吸窘迫综合征的预后。? 【关键词】血浆置换；连续性静脉-静脉血液滤过；急性呼吸窘迫综合征；C反应蛋白 ?? Clinical objection on ARDS treated with plasma exchange and continuous venous-venous hemofiltration ? JIANHong-yun,ZHOUZai-sheng,OU Xiu-yan,et al.The Peoples Hospital Zhongshan City 528400,China ? 【Abstract】 Objective To investigate the effect of plasma exchange(PE)and continuous venous-venous hemofiltration,(CVVH)in the treatment of patientswith acute respiratory distress syndromeARDS.Methods 20 patients with ARDS were treated with PE and CVVH except general management,MAP,HR,CVP,PaO2，PaCO2，PaO2/FiO2，dynamic lung compliance(Gdyn)airway resistance(Raw)and C-reactive protein(CRP)were measured and recorded before and after PE.CVVH treatment.Results All the patients tolerated the treatment of PE and CVVH.The data showed that MAP,HR,CVP,PaO2，PaCO2，PaO2/FiO2，dynamic lung compliance(Gdyn)airway resistance(Raw)C-reactive protein(CRP)were significant chang following PE(P0．05),so did the APACHE II SIRS after CVVH(P0．05).Conclusion The data indicated that PE and CVVH were effective methods for improving ARDS.It might be of clinical benefit to the prognosis of patients with ARDS.? 【Key words】Plasma exchange; Continuous venous-venous hemofiltration; Acute respiratory distressyndromr;C-reactive protein 急性呼吸窘迫综合征(Acute respiratory distressyndromr,ARDS)是指 由心源性以外的各种肺内、外致病因素导致的急性、进行性呼吸衰竭。是一组连续变化的临床综合征。往往是多器管功能障碍综合征(MODS)中最早出现的器管功能障碍，是机体对感染性或非感染性致病因素的过度炎症反应状态，是一种常见的临床综合征[1]。以单纯中和