發(fā)布時(shí)間：2018-06-04 16:36

  本文選題：血液灌流 + 高容量血液濾過　； 參考：《天津醫(yī)科大學(xué)》2013年碩士論文

【摘要】：急性呼吸窘迫綜合征(ARDS)是一種以進(jìn)行性呼吸困難和頑固性低氧血癥為特征的急性呼吸衰竭,病死率高。此病大多由于直接或間接的肺損傷而產(chǎn)生失控的系統(tǒng)性炎癥反應(yīng)。研究表明,細(xì)胞因子和炎癥介質(zhì)在ARDS局部炎癥的發(fā)生、發(fā)展和全身炎癥反應(yīng)中起著重要的作用。目前用機(jī)械通氣治療以及保護(hù)性肺通氣策略的提出雖提高ARDS患者的搶救成功率,但尚無有效方法中止ARDS的炎癥性肺損傷,使得ARDS的病死率居高不下。本研究著重探討血液灌流(HP)聯(lián)合高容量血液濾過(HVHF)對(duì)ARDS患者呼吸功能和預(yù)后的影響。 目的觀察血液灌流聯(lián)合高容量血液濾過對(duì)急性呼吸窘迫綜合征(Acute Respiratory Distress Syndrome, ARDS)患者呼吸功能和預(yù)后的影響。 方法按隨機(jī)原則將急性呼吸窘迫綜合征患者分為常規(guī)對(duì)照組(HVHF)20例,血液灌流聯(lián)合高容量血液濾過組(HP+HVHF)20例。兩組患者按中華醫(yī)學(xué)會(huì)重癥醫(yī)學(xué)分會(huì)急性肺損傷／急性呼吸窘迫綜合征診斷和治療指南常規(guī)治療及高容量血液濾過治療,HP+HVHF組同時(shí)進(jìn)行血液灌流治療。分別于治療前及治療24小時(shí)、72小時(shí)行動(dòng)脈血?dú)夥治�、血清炎癥介質(zhì)、檢測(cè)氣道峰壓、肺順應(yīng)性,并觀察患者重癥監(jiān)護(hù)病房(ICU)住院時(shí)間、機(jī)械通氣時(shí)間及28天病死率。 結(jié)果血液灌流聯(lián)合高容量血液濾過(HP+HVHF)組患者及機(jī)械通氣時(shí)間(d)及高容量血液濾過治療(HVHF)時(shí)間(d)均明顯短于對(duì)照組(7.50±4.51比13.00±7.57；6.65±4.48比8.85±4.25,均P0.05)；治療72小時(shí)后,兩組急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHE Ⅱ)評(píng)分(分)均明顯下降,且治療組(HP+HVHF治療)下降程度優(yōu)于對(duì)照組(15.75±4.96比18.95±7.01,P0.05)：呼吸指數(shù)和氧合指數(shù)在72小時(shí)后治療組較對(duì)照組有顯著性差異(3.09±0.49比3.44±0.45；242.95±55.58比179.90±65.31,P0.05)。治療組24小時(shí)和72小時(shí)氣道峰壓、肺順應(yīng)性均較治療前有明顯改善(P0.05)。對(duì)照組在治療72小時(shí)后氣道峰壓、肺順應(yīng)性均較治療前改善P0.05。在治療24小時(shí)和72小時(shí)后,治療組TNF-a、IL-6和IL-8三種細(xì)胞因子下降水平均較對(duì)照組有顯著性差異(均P0.05)。治療組內(nèi)中,72小時(shí)后TNF-a、IL-6和IL-8三種細(xì)胞因子較24小時(shí)下降明顯且有顯著性差異(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) 結(jié)論血液灌流聯(lián)合高容量血液濾過在ARDS的急性期顯著降低了影響肺功能的細(xì)胞因子的峰值濃度,減輕病情的嚴(yán)重程度,改善預(yù)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 鹵4.51 vs 13.00 鹵7.57 鹵6.65 鹵4.48 vs 8.85 鹵4.25, respectively, P0.055.After 72 hours of treatment, the time of hypervolemic hemofiltration was 7.50 鹵4.51 vs 8.85 鹵4.25, P < 0.05). The scores of acute physiology and chronic health status 鈪，

本文編號(hào)：1978064