CAJ | 학술논문

目的探讨持续静脉-静脉血液滤过(CVVH)对危重症甲型H1N1流感患者呼吸功能的影响.方法通过对入选的10例甲型H1N1流感危重症患者在常规治疗的基础上联合应用CVVH治疗,分别观察干预前及干预后24 h、48 h、72 h、120 h的血清炎性介质水平[肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、IL-8、IL-10]、呼吸力学指标(气道压、静态顺应性、氧合指数)、血管外肺水、血气分析指标(PaO2、PaCO2、pH)及APACHEⅡ评分.结果与CVVH干预前相比,干预后72 h、120 h血液中的TNF-α、IL-6、IL-8均下降(P＜0.05);CVVH治疗后72 h患者的气道压、静态顺应性、氧合指数趋于稳定,与CVVH干预前相比差异有统计学意义(P＜0.05);血管外肺水与治疗前相比,48 h后开始逐渐回落(P＜0.05);PaO2、PaCO2在CVVH 72 h后开始明显好转,与治疗前相比差异有统计学意义(P ＜0.05),氧合指数的改变在48 h后即有明显改善(P＜0.05),72 h后一直稳定在正常水平;同时APACHEⅡ评分72 h后也显著降低(P＜0.05).结论 CVVH可以清除危重症甲流患者部分炎性介质,清除血管外肺水,改善患者呼吸功能,提高抢救成功率.
목적 탐토지속정맥-정맥혈액려과(CVVH)대위중증갑형H1N1류감환자호흡공능적영향.방법 통과대입선적10례갑형H1N1류감위중증환자재상규치료적기출상연합응용CVVH치료,분별관찰간예전급간예후24 h、48 h、72 h、120 h적혈청염성개질수평[종류배사인자α(TNF-α)、백개소6(IL-6)、IL-8、IL-10]、호흡역학지표(기도압、정태순응성、양합지수)、혈관외폐수、혈기분석지표(PaO2、PaCO2、pH)급APACHEⅡ평분.결과 여CVVH간예전상비,간예후72 h、120 h혈액중적TNF-α、IL-6、IL-8균하강(P＜0.05);CVVH치료후72 h환자적기도압、정태순응성、양합지수추우은정,여CVVH간예전상비차이유통계학의의(P＜0.05);혈관외폐수여치료전상비,48 h후개시축점회락(P＜0.05);PaO2、PaCO2재CVVH 72 h후개시명현호전,여치료전상비차이유통계학의의(P ＜0.05),양합지수적개변재48 h후즉유명현개선(P＜0.05),72 h후일직은정재정상수평;동시APACHEⅡ평분72 h후야현저강저(P＜0.05).결론 CVVH가이청제위중증갑류환자부분염성개질,청제혈관외폐수,개선환자호흡공능,제고창구성공솔.
Objective To explore the effects of continuous veno-venous hemofiltration (CVVH) on respiratory function of critical patients with influenza A/H1N1. Methods Ten cases of influenza A/H1N1 eceived CVVH on the basis of conventional therapy. Before and at 24th, 48th, 72nd, 120th hour after intervention, serum inflammatory mediators [tumor necrosis factor-α (TNF-α) ,interleukin-6 (IL-6), IL-8,IL-10], respiratory mechanics indexes (airway pressure, static compliance, oxygenation index),extravascular lung water, blood gas analysis indexes (PaO2, PaCO2, pH) and APACHE Ⅱ score were determined. Results Compared with before CVVH intervention, TNF-α, IL-6, IL-8 in blood at 72th,120th hour after intervention were significantly decreased ( P ＜0.05). There was statistical significance on airway pressure, static compliance, oxygenation index between before CVVH intervention and at 72th hour after intervention ( P ＜0.05). Extravascular lung water gradually declined from 48th hour after intervention ( P ＜0.05). Compared with before treatment, PaO2, PCO2 improved at 72th hour after intervention ( P ＜0.05). Oxygenation index improved at 48th hour after intervention ( P ＜0.05), and had been stable at normal level at 72th hour after intervention. Meanwhile, APACHE Ⅱ score decreased at 72th hour after intervention ( P ＜0. 05). Conclusions For critical patients with influenza A/H1N1,CVVH can remove some inflammatory mediators and extravascular lung water, improve respiratory function, and increase the success rate of rescue.