中国医药
中國醫藥
중국의약
CHINA MEDICINE
2012年
9期
1074-1076
,共3页
呼吸窘迫综合征,成人%连续性血液净化%炎性介质
呼吸窘迫綜閤徵,成人%連續性血液淨化%炎性介質
호흡군박종합정,성인%련속성혈액정화%염성개질
Respiratory distress syndrome,adult%Continuous blood purification%Inflammatory mediators
目的 观察连续性血液净化对肺外源性急性呼吸窘迫综合征(ARDS)患者的影响.方法 将因肺外源性病因引起的ARDS患者46例完全随机分为2组:观察组(n=26)常规治疗外给予连续性血液净化联合机械通气；对照组(n=20)常规治疗外给予机械通气.观察2组治疗前及治疗后第1、3天的急性生理和慢性健康评分( APACHEⅡ)、血浆高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、氧合指数及机械通气时间.结果 观察组治疗后第1、3天hs-CRP[对照组分别为(102±22)、(64±17)mg/L比(138 ±29) mg/L,观察组分别为(126±21)、(118±18)mg/L比(132±28) mg/L]、IL-6[对照组分别为(16±5)、(13±4) μg/L比(24±7)μg/L,观察组分别为(24±6)、(22±4)μg/L比(25±7)μg/L]、TNF-α[对照组分别为(402±25)、(286±17 )ng/L比(506±30) ng/L,观察组分别为(498 ±29)、(468±26)ng/L比(502±30)ng/L]的下降及动脉血氧合指数的改善明显优于治疗前,亦优于对照组同时点；2组治疗后第1、3天APACHEⅡ分值[对照组分别为(26±6)、(22±5)分比(29±7)分,观察组分别为(22±5)、(18±4)分比(30±7)分,均P＜0.05]及动脉血氧合指数均明显优于治疗前[对照组分别为(186 ±40)、(220±43)比(170±37),观察组分别为(246±44)、(320±56)比(168±37),均P＜0.05],观察组在改善程度上明显优于对照组,差异均有统计学意义(均P＜0.05).观察组机械通气时间明显短于对照组[(4±2)d比(7±3)d,P＜0.05].结论 连续性血液净化能有效清除肺外源性ARDS患者体内炎性递质,改善氧合,缩短机械通气时间.
目的 觀察連續性血液淨化對肺外源性急性呼吸窘迫綜閤徵(ARDS)患者的影響.方法 將因肺外源性病因引起的ARDS患者46例完全隨機分為2組:觀察組(n=26)常規治療外給予連續性血液淨化聯閤機械通氣；對照組(n=20)常規治療外給予機械通氣.觀察2組治療前及治療後第1、3天的急性生理和慢性健康評分( APACHEⅡ)、血漿高敏C反應蛋白(hs-CRP)、白細胞介素6(IL-6)、腫瘤壞死因子α(TNF-α)、氧閤指數及機械通氣時間.結果 觀察組治療後第1、3天hs-CRP[對照組分彆為(102±22)、(64±17)mg/L比(138 ±29) mg/L,觀察組分彆為(126±21)、(118±18)mg/L比(132±28) mg/L]、IL-6[對照組分彆為(16±5)、(13±4) μg/L比(24±7)μg/L,觀察組分彆為(24±6)、(22±4)μg/L比(25±7)μg/L]、TNF-α[對照組分彆為(402±25)、(286±17 )ng/L比(506±30) ng/L,觀察組分彆為(498 ±29)、(468±26)ng/L比(502±30)ng/L]的下降及動脈血氧閤指數的改善明顯優于治療前,亦優于對照組同時點；2組治療後第1、3天APACHEⅡ分值[對照組分彆為(26±6)、(22±5)分比(29±7)分,觀察組分彆為(22±5)、(18±4)分比(30±7)分,均P＜0.05]及動脈血氧閤指數均明顯優于治療前[對照組分彆為(186 ±40)、(220±43)比(170±37),觀察組分彆為(246±44)、(320±56)比(168±37),均P＜0.05],觀察組在改善程度上明顯優于對照組,差異均有統計學意義(均P＜0.05).觀察組機械通氣時間明顯短于對照組[(4±2)d比(7±3)d,P＜0.05].結論 連續性血液淨化能有效清除肺外源性ARDS患者體內炎性遞質,改善氧閤,縮短機械通氣時間.
목적 관찰련속성혈액정화대폐외원성급성호흡군박종합정(ARDS)환자적영향.방법 장인폐외원성병인인기적ARDS환자46례완전수궤분위2조:관찰조(n=26)상규치료외급여련속성혈액정화연합궤계통기；대조조(n=20)상규치료외급여궤계통기.관찰2조치료전급치료후제1、3천적급성생리화만성건강평분( APACHEⅡ)、혈장고민C반응단백(hs-CRP)、백세포개소6(IL-6)、종류배사인자α(TNF-α)、양합지수급궤계통기시간.결과 관찰조치료후제1、3천hs-CRP[대조조분별위(102±22)、(64±17)mg/L비(138 ±29) mg/L,관찰조분별위(126±21)、(118±18)mg/L비(132±28) mg/L]、IL-6[대조조분별위(16±5)、(13±4) μg/L비(24±7)μg/L,관찰조분별위(24±6)、(22±4)μg/L비(25±7)μg/L]、TNF-α[대조조분별위(402±25)、(286±17 )ng/L비(506±30) ng/L,관찰조분별위(498 ±29)、(468±26)ng/L비(502±30)ng/L]적하강급동맥혈양합지수적개선명현우우치료전,역우우대조조동시점；2조치료후제1、3천APACHEⅡ분치[대조조분별위(26±6)、(22±5)분비(29±7)분,관찰조분별위(22±5)、(18±4)분비(30±7)분,균P＜0.05]급동맥혈양합지수균명현우우치료전[대조조분별위(186 ±40)、(220±43)비(170±37),관찰조분별위(246±44)、(320±56)비(168±37),균P＜0.05],관찰조재개선정도상명현우우대조조,차이균유통계학의의(균P＜0.05).관찰조궤계통기시간명현단우대조조[(4±2)d비(7±3)d,P＜0.05].결론 련속성혈액정화능유효청제폐외원성ARDS환자체내염성체질,개선양합,축단궤계통기시간.
Objective To evaluate the effect of continuous blood purification (CBP)on serum levels of proinflammatory cytokines and clinical outcome in patients with extrapulmonary acute respiratory distress syndrome (ARDS).Methods Forty-six patients with a diagnosis of extrapulmonary ARDS were enrolled and randomized into observation group (n =26 )and control group (n =20 ). The patients in control group received conventional treatment including mechanical ventilation,while patients in observation group were treated with continuous blood purification in addition to the routine treatment.The acute physiology and chronic health evaluation (APACHE)Ⅱ score,oxygenation index,and blood levels of high-sensitivity C-reactive protein (hs-CRP ),interleukin-6 (IL-6 )and tumor necrosis factor alpha (TNF-α )were measured on baseline,day 1 and day 3 after study enrollment.Moreover,duration of mechanical ventilation was also recorded.Results Compared with control group,patients in observation group experienced significant improvement in APACHE Ⅱ score and oxygenation index (P＜0.05 ).Serum levels of hs-CRP,IL-6 and TNF-α decreased more rapidly in patients with observation group (P＜0.05 ).Duration of mechanical ventilation in observation group was much shorter (P＜0.05).Conclusion In patients with extrapulmonary ARDS,continuous blood purification can improve clinical outcome,possibly secondary to removal of pro-inflammatory mediators.
