连续性高容量血液滤过对脓毒症合并重度急性呼吸窘迫综合征的疗效分析.docVIP

连续性高容量血液滤过对脓毒症合并重度急性呼吸窘迫综合征的疗效分析 吴燕燕1 ，赵金川1，鲁力2（400014重庆，重庆市急救医疗中心：1急诊科，2ICU） [摘要] 目的 探讨连续性高容量血液滤过(continuous highvolume hemofiltration , CHVHF)治疗脓毒症相关重度急性呼吸窘迫综合征(ARDS)的临床疗效。方法 回顾性分析2008年1月至2014年12月入住我院重症监护室（ICU）的117例脓毒症相关重度ARDS患者进行研究，按是否接受CHVHF分为血滤组(49例)和常规组(68例)，常规组接受常规治疗，血滤组在常规治疗基础上应用CHVHF治疗。观察两组患者治疗前及治疗后6、24、48、72 h氧合指数(PaO2/FiO2)、血管外肺水指数(EVLWI)、动脉血二氧化碳分压(Pa2)等呼吸功能指标；以及血流动力学参数如心率(HR)、平均动脉压(MAP)的变化并观察机械通气的持续时间、住ICU天数、撤机成功率、28 d存活率等指标。结果 两组治疗后血流动力学指标HR、MAP较治疗前均有明显改善，两组间没有显著差异。血滤组的 h PaO2/FiO2[(122.4±9.6)mmHg]、24 h EVLWI、24 hPaC2[(46.7±6.2)mmHg]等肺功能指标较常规组[()mmHg、(12.8±2.6)mL/kg、(50.8±4.4)mmHg]改善明显。血滤组机械通气时间()d、住ICU天数()比与常规组[()、(35.0±6.3)]明显缩短血滤组撤机成功率()、28 d存活率()较常规组[()、(63.3%)]高。 [关键词]连续性高容量血液滤过； 急性呼吸窘迫综合征； 脓毒症 [中图法分类号] [文献标志码] A Effect of continuous high-volume hemofiltration in patients with sepsis and severe acute respiratory distress syndrome WuYanyan1, Zhao Jinchuan1, Lu Li2 (Department of Emergency Medicine1 ，Department of Critical Care Medicine2，Chongqing emergency medical center Chongqing 400014) [Abstract] Objective To investigate the effect of continuous high-volume hemofiltration(CHVHF)in patients with sepsis and severe acute respiratory distress syndrome(ARDS)．MethodsA retrospective study was conducted． patients with sepsis and severe ARDS admitted to intensive care unit(ICU)from January 2008 to December 2014 were divided into control group(n=49)and treatment group(n=68)．Patients in treatment group were treated with CHVHF and other routine treatments．Patients in control group received routine treatments only．The oxygenation index (PaOFiO2)，extravascular lung water index(EVLWI)，arterial partial pressure of carbon dioxide(PaC2)，heart rate(HR)，mean arterial pressure(MAP)interleukin-6(IL-6) level, C reactive protein(CRP) level were compared between control group and treatment group before and 6，24，48，72 treatment．The duration of mechanical ventilation(MV)，ICU stay time，percentage of weaning from MV，and 28-day survival rate were