CAJ | 학술논문

目的探讨持续静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)对甲型H1N1流感呼吸衰竭患者氧代谢、血管外肺水的影响.方法通过对入选的10例甲型H1N1流感呼吸衰竭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后的血流动力学指标及血管外肺水[心率(heart rate,HR)、平均肺动脉压(mean pulmonary artery pressure,MPAP)、肺动脉楔压(pulmonary artery wedge pressure,PAWP)、外周血管阻力(peripheral vascular resistance,SVR)、肺血管阻力(pulmonary vascular resistance,PVR)、心排血量(cardiac output,CO)、肺胸腔液体含量(thoracic fluid content,TFC)],24 h、48 h、72 h后的氧代谢指标[氧输送(oxygen delivery,DO2)、氧摄取(oxygen extraction,VO2)和氧摄取率(oxygen extraction rate,ERO2)]以及急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)Ⅱ.结果与CVVH干预前比较,48 h后HR、TFC和72 h的SVR、PVR均明显下降,CO、PAWP及MPAP在120 h后逐渐趋向稳定,与CVVH治疗前比较差异有统计学意义( P＜0.05);TFC 与治疗前比较,48 h后逐渐回落,差异有统计学意义(P＜0.05);氧代谢观察:CVVH治疗前DO 2、ERO2、VO2均明显增高,同时伴有动脉血氧分压的下降,CVVH 治疗72 h后DO2、ERO2、VO2 逐渐稳定,同时伴有氧合指数及动脉血氧分压的上升;此外患者的APACHE Ⅱ 72 h后也显著降低(P＜0.05).结论 CVVH可以明显改善患者氧代谢、清除血管外肺水,改善呼吸功能,提高抢救成功率.
목적 탐토지속정정맥혈액려과(continuous veno-venous hemofiltration,CVVH)대갑형H1N1류감호흡쇠갈환자양대사、혈관외폐수적영향.방법 통과대입선적10례갑형H1N1류감호흡쇠갈환자재상규치료적기출상연합응용CVVH치료,분별관찰간예전급간예후24 h、48 h、72 h、120 h후적혈류동역학지표급혈관외폐수[심솔(heart rate,HR)、평균폐동맥압(mean pulmonary artery pressure,MPAP)、폐동맥설압(pulmonary artery wedge pressure,PAWP)、외주혈관조력(peripheral vascular resistance,SVR)、폐혈관조력(pulmonary vascular resistance,PVR)、심배혈량(cardiac output,CO)、폐흉강액체함량(thoracic fluid content,TFC)],24 h、48 h、72 h후적양대사지표[양수송(oxygen delivery,DO2)、양섭취(oxygen extraction,VO2)화양섭취솔(oxygen extraction rate,ERO2)]이급급성생이학여만성건강상황평분(acute physiology and chronic health evaluation,APACHE)Ⅱ.결과 여CVVH간예전비교,48 h후HR、TFC화72 h적SVR、PVR균명현하강,CO、PAWP급MPAP재120 h후축점추향은정,여CVVH치료전비교차이유통계학의의( P＜0.05);TFC 여치료전비교,48 h후축점회락,차이유통계학의의(P＜0.05);양대사관찰:CVVH치료전DO 2、ERO2、VO2균명현증고,동시반유동맥혈양분압적하강,CVVH 치료72 h후DO2、ERO2、VO2 축점은정,동시반유양합지수급동맥혈양분압적상승;차외환자적APACHE Ⅱ 72 h후야현저강저(P＜0.05).결론 CVVH가이명현개선환자양대사、청제혈관외폐수,개선호흡공능,제고창구성공솔.