本文關(guān)鍵詞：急性呼吸窘迫綜合征患者血液凈化治療的臨床觀察　出處：《華中科技大學(xué)學(xué)報(醫(yī)學(xué)版)》2016年06期 　論文類型：期刊論文

  更多相關(guān)文章： 急性呼吸窘迫綜合征 連續(xù)性血液凈化 臨床指標(biāo) 炎性因子

【摘要】：目的探討連續(xù)性血液凈化治療對急性呼吸窘迫綜合征(acute respiratory distress syndrome,ARDS)患者的臨床作用和治療時機(jī)。方法 ARDS患者96例,按數(shù)字隨機(jī)表法和APPACHEⅡ評分分為A1組和B1組(APPACHEⅡ≥20分),A2組和B2組(15分≤APPACHEⅡ20分),每組24例。A1和A2組患者在給予病因治療和早期臟器功能支持治療等常規(guī)治療的基礎(chǔ)上給予連續(xù)性血液凈化治療,B1和B2組僅給予常規(guī)治療。在連續(xù)性血液凈化治療開始及治療后72h,觀察各組患者治療前后臨床生化、危重評分、血漿和超濾液中炎性因子水平、臨床指標(biāo);監(jiān)測各組患者血流動力學(xué)和呼吸力學(xué)參數(shù)。結(jié)果 1治療后72h,4組患者心指數(shù)(cardiac index,CI)、全心舒張末期容積指數(shù)GEDVI、血管外肺水指數(shù)(extravascular lung water index,EVLWI)、肺血管通透性(PVPI)和乳酸(LAC)均降低,氧合指數(shù)升高,但A1組下降和升高程度更明顯(均P0.05)。2治療后72h,4組患者氣道峰壓(peak inspiratory pressure,PIP)、氣道平臺壓(plateau pressure,Pplat)、氣道平均壓(mean airway pressure,MPaw)、有效靜態(tài)總順應(yīng)性(Cst)均降低,但A1組下降程度更明顯(均P0.05)。3治療后72h,4組患者血漿炎性因子如腫瘤壞死因子-α(TNF-α)、白細(xì)胞介素-6(IL-6)濃度均降低,A1組降低更明顯(均P0.05)。4治療后72h,4組患者APACHEⅡ、MODS、Murray和SIRS評分均降低,但A1組下降程度更明顯(均P0.05);治療2周后,給予連續(xù)性血液凈化治療的A1、A2組患者M(jìn)ODS發(fā)生率、死亡率、機(jī)械通氣時間、住ICU時間均低于相對應(yīng)的常規(guī)治療的B1、B2組,但A1組獲益更明顯(均P0.05)。結(jié)論連續(xù)性血液凈化治療能降低炎癥因子水平,改善ARDS患者的血流動力學(xué)、呼吸力學(xué)狀況,改善患者預(yù)后。
[Abstract]:Objective to investigate the effect of continuous blood purification therapy on acute respiratory distress syndrome (acute respiratory distress syndrome, ARDS) the timing of clinical effects and treatment of patients. Methods 96 cases of ARDS patients were randomly divided into A1 and APPACHE II score group and B1 group (APPACHE II more than 20 cent), A2 group and B2 group (15 < APPACHE II 20), 24 cases in each group and.A1 A2 group were treated with continuous blood purification therapy based on routine treatment given etiological treatment and early organ function support treatment on the B1 and B2 group were only given conventional therapy. Treatment began after treatment and 72h in continuous blood, clinical biochemistry and the critical score before and after treatment in patients with clinical observation indexes in plasma and ultrafiltrate levels of inflammatory cytokines were measured; hemodynamics and respiratory mechanics parameters. Results 1 72h after treatment, 4 groups of patients with cardiac index (cardiac index, CI), heart Shu 寮犳湯鏈熷縐寚鏁癎EDVI,琛，

本文編號：1428517