中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
12期
755-758
,共4页
张继承%任宏生%蒋进皎%丁敏%孟玫%曾娟%楚玉峰%朱文瑛%郄国强%王鹏%王春亭
張繼承%任宏生%蔣進皎%丁敏%孟玫%曾娟%楚玉峰%硃文瑛%郄國彊%王鵬%王春亭
장계승%임굉생%장진교%정민%맹매%증연%초옥봉%주문영%극국강%왕붕%왕춘정
6％羟乙基淀粉130/0.4%高容量血液滤过%肺损伤,急性%肾损伤,急性
6％羥乙基澱粉130/0.4%高容量血液濾過%肺損傷,急性%腎損傷,急性
6％간을기정분130/0.4%고용량혈액려과%폐손상,급성%신손상,급성
6 ％ hydroxyethyl starch%High-volume hemofiltration%Acute lung injury%Acute kidney injury
目的 探讨6％羟乙基淀粉130/0.4(万汶)联合高容量血液滤过(HVHF)对急性肺损伤(ALI)、急性肾损伤(AKI)患者的影响.方法 选取2006年8月至2011年5月山东大学附属省立医院重症医学科108例ALI合并AKI患者,按入院顺序随机分为万汶组(68例)和万汶+HVHF组(40例).两组均静脉滴注万汶进行容量复苏,万汶+HVHF组完成72 h HVHF.比较两组治疗前后动脉血乳酸(Lac)、血清高敏C-反应蛋白(hs-CRP),以及反映ALI的指标肺泡-动脉血氧分压差(PA-aDO2)、氧合指数(OI)和反映AKI的指标血清胱抑素C(Cyst C)、肌酐清除率(CCr)的变化.结果 与万汶组比较,万汶+HVHF组治疗72 h血Lac(mmol/L)、hs-CRP(mg/L)、PA-aDO2(mm Hg,1 mm Hg=0.133 kPa)、血Cyst C(mg/L)显著下降(Lac:1.7±0.7比2.7±1.5;hs-CRP:35.8±18.8比99.5±20.4;PAaDO2:115.5±23.1比155.4±27.4;Cyst C:2.06±1.12比3.95±2.06,均P＜0.01),OI(mm Hg)、血CCr(ml/min)显著升高(OI:295.2±38.8比239.5±32.7；CCr:108.71±31.33比90.21±30.35,均P＜0.01).治疗7d后,万汶+HVHF组病死率显著低于万汶组[10.00％(4/40)比29.41％(20/68),P＜0.05].结论 万汶联合HVHF治疗能改善ALI、AKI患者的器官功能,防治多器官功能障碍综合征的发生.
目的 探討6％羥乙基澱粉130/0.4(萬汶)聯閤高容量血液濾過(HVHF)對急性肺損傷(ALI)、急性腎損傷(AKI)患者的影響.方法 選取2006年8月至2011年5月山東大學附屬省立醫院重癥醫學科108例ALI閤併AKI患者,按入院順序隨機分為萬汶組(68例)和萬汶+HVHF組(40例).兩組均靜脈滴註萬汶進行容量複囌,萬汶+HVHF組完成72 h HVHF.比較兩組治療前後動脈血乳痠(Lac)、血清高敏C-反應蛋白(hs-CRP),以及反映ALI的指標肺泡-動脈血氧分壓差(PA-aDO2)、氧閤指數(OI)和反映AKI的指標血清胱抑素C(Cyst C)、肌酐清除率(CCr)的變化.結果 與萬汶組比較,萬汶+HVHF組治療72 h血Lac(mmol/L)、hs-CRP(mg/L)、PA-aDO2(mm Hg,1 mm Hg=0.133 kPa)、血Cyst C(mg/L)顯著下降(Lac:1.7±0.7比2.7±1.5;hs-CRP:35.8±18.8比99.5±20.4;PAaDO2:115.5±23.1比155.4±27.4;Cyst C:2.06±1.12比3.95±2.06,均P＜0.01),OI(mm Hg)、血CCr(ml/min)顯著升高(OI:295.2±38.8比239.5±32.7；CCr:108.71±31.33比90.21±30.35,均P＜0.01).治療7d後,萬汶+HVHF組病死率顯著低于萬汶組[10.00％(4/40)比29.41％(20/68),P＜0.05].結論 萬汶聯閤HVHF治療能改善ALI、AKI患者的器官功能,防治多器官功能障礙綜閤徵的髮生.
목적 탐토6％간을기정분130/0.4(만문)연합고용량혈액려과(HVHF)대급성폐손상(ALI)、급성신손상(AKI)환자적영향.방법 선취2006년8월지2011년5월산동대학부속성립의원중증의학과108례ALI합병AKI환자,안입원순서수궤분위만문조(68례)화만문+HVHF조(40례).량조균정맥적주만문진행용량복소,만문+HVHF조완성72 h HVHF.비교량조치료전후동맥혈유산(Lac)、혈청고민C-반응단백(hs-CRP),이급반영ALI적지표폐포-동맥혈양분압차(PA-aDO2)、양합지수(OI)화반영AKI적지표혈청광억소C(Cyst C)、기항청제솔(CCr)적변화.결과 여만문조비교,만문+HVHF조치료72 h혈Lac(mmol/L)、hs-CRP(mg/L)、PA-aDO2(mm Hg,1 mm Hg=0.133 kPa)、혈Cyst C(mg/L)현저하강(Lac:1.7±0.7비2.7±1.5;hs-CRP:35.8±18.8비99.5±20.4;PAaDO2:115.5±23.1비155.4±27.4;Cyst C:2.06±1.12비3.95±2.06,균P＜0.01),OI(mm Hg)、혈CCr(ml/min)현저승고(OI:295.2±38.8비239.5±32.7；CCr:108.71±31.33비90.21±30.35,균P＜0.01).치료7d후,만문+HVHF조병사솔현저저우만문조[10.00％(4/40)비29.41％(20/68),P＜0.05].결론 만문연합HVHF치료능개선ALI、AKI환자적기관공능,방치다기관공능장애종합정적발생.
Objective To evaluate the effects of administration of 6％ hydroxyethyl starch(6％ HES 130/0.4,voluven)in combination with high volume hemofiltration(HVHF)in patients with ALI and AKI.Methods One hundred and eight patients with acute lung injury(ALI)and acute kidney injury(AKI)were enrolled from Department of Intensive Care Unit(ICU)of the Provincial Hospital Affiliated to Shandong University between August 2006 and May 2011.The patients were randomly divided into two groups A(n=68)and B(n=40)to receive voluven(i.v.,for volume resuscitation)and voluven+HVHF for 72 hours.The arterial blood lactate concentration(Lac),high sensitivity C-reactive protein(hs-CRP)serum concentration,pulmonary function index lveolar-arterial oxygen pressure difference(PAa DO2)and oxygenation index(OI),as well as kidney function index serum cystatin C(Cyst C)and serum creatinine clearance rate(CCr)were measured at the time of admission and 72 hours after the treatment for statistical analysis.Results In comparison with group A,group B had significantly(all P＜0.01)lower mean value in the level of arterial Lac(mmol/L:1.7±0.7 vs.2.7±1.5),serum hs-CRP(mg/L:35.8±18.8 vs.99.5±20.4),PAaDO2(mmHg,1 mmHg=0.133kPa:115.5±23.1 vs.155.4±27.4),Cyst C(mg/L:2.06±1.12 vs.3.95±2.06)and significantly higher(both P＜0.01)mean value of OI(mm Hg:295.2±38.8 vs.239.5 ± 32.7)and CCr(ml/min:108.71± 31.33 vs.90.21 ± 30.35)72 hours after treatment.The mortality rate of group B was significantly lower than group A[10.00％(4/40)vs.29.41 ％(20/68),P＜0.05]7 days after the admission.Conclusion 6％ HES 130/0.4 in ombination with HVHF could improve the lung and kidney function of the patients with ALI and AKI,prevent the development of multiple organ dysfunction syndrome(MODS),therefore improve the survival rate of these patients.
