【摘要】：目的探討高容量血液濾過(HVHF)對(duì)急性呼吸窘迫綜合征(ARDS)患者炎性介質(zhì)及氧代謝的影響。方法將72例ARDS患者分為HVHF組(36例)和對(duì)照組(36例),兩組的常規(guī)治療方法相同,HVHF組在常規(guī)治療的基礎(chǔ)上給予HVHF治療。比較兩組患者治療前及治療72 h后炎性介質(zhì)、氧代謝指標(biāo)及生命體征的變化,并記錄兩組患者的機(jī)械通氣時(shí)間、ICU住院時(shí)間及4周內(nèi)病死率。結(jié)果治療前兩組患者的炎性介質(zhì)(TNF-α、IL-1、IL-6、hs-CRP、PCT)、氧代謝指標(biāo)(Pv O2、Pa O2/Fi O2、VO2、DO2)及生命體征(HR、MAP、APACHEⅡ評(píng)分、MODS評(píng)分)比較差異無統(tǒng)計(jì)學(xué)意義(均P0.05),具有可比性;治療72 h后兩組患者的炎性介質(zhì)(TNF-α、IL-1、IL-6、hs-CRP、PCT)、氧代謝指標(biāo)(Pv O2、Pa O2/Fi O2、VO2、DO2)及生命體征(HR、MAP、APACHEⅡ評(píng)分、MODS評(píng)分)均較治療前有顯著改善(P0.05,P0.01),而HVHF組患者較對(duì)照組改善更顯著(P0.01);HVHF組患者的機(jī)械通氣時(shí)間、ICU住院時(shí)間明顯短于對(duì)照組(t=2.588 8、2.581 8,均P0.05),4周內(nèi)病死率明顯低于對(duì)照組(醊2=4.430 7,P0.05)。結(jié)論 HVHF治療能更有效地改善ARDS患者的氧代謝和生命體征,降低APACHEⅡ評(píng)分、MODS評(píng)分,縮短機(jī)械通氣時(shí)間和ICU住院時(shí)間,降低4周內(nèi)病死率,其機(jī)制可能與更有效地清除體內(nèi)炎癥介質(zhì)有關(guān)。
[Abstract]:Objective to investigate the effect of hypervolemic hemofiltration (HVHF) on inflammatory mediators and oxygen metabolism in patients with acute respiratory distress syndrome (ARDS). Methods 72 patients with ARDS were divided into HVHF group (n = 36) and control group (n = 36). The routine treatment methods of the two groups were the same. HVHF group was treated with HVHF on the basis of routine treatment. The changes of inflammatory mediators, oxygen metabolism indexes and vital signs were compared between the two groups before and 72 hours after treatment, and the mechanical ventilation time, hospitalization time of ICU and mortality within 4 weeks were recorded. Results there were no significant differences in inflammatory mediators (TNF- 偽, IL-1,IL-6,hs-CRP,PCT), oxygen metabolism indexes (Pv O 2, Pa O2/Fi O 2, VO 2, do 2) and vital signs (HR,MAP, Apache 鈪，

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