CAJ | 학술논문

目的探讨连续性血液净化(CBP)治疗改善危重哮喘患者肺机械通气参数、细胞因子水平、血气分析结果的机制.比较应用碳酸氢盐置换液与乳酸盐置换液在以上方面的差别.方法 26例危重哮喘患者按随机数字表法分为对照组(10例)、碳酸氢盐CBP组(8例)、乳酸盐CBP组(8例),分别应用单纯机械通气、机械通气+碳酸氢盐置换液CBP、机械通气+乳酸盐置换液CBP治疗24 h,比较3种治疗方法对肺机械通气参数、血清细胞因子、血气分析、动脉血乳酸、电解质的影响.结果碳酸氧盐CBP组、乳酸盐CBP组治疗24h后肺机械通气参数改善,细胞因子水平下降,pH值及氧分压得到改善；两种置换液对血清电解质、动脉血氧分压(PaO2)、动脉血乳酸无明显影响.乳酸盐CBP组pH值明显高于碳酸氢盐CBP组(7.39±0.05比7.30±0.01,P＜0.01),动脉血二氧化碳分压(PaCO2,mm Hg,1 mm Hg=0.133 kPa)明显低于碳酸氢盐CBP组(57.14±5.04比89.00±3.66,P＜0.01).结论联合应用CBP治疗危重哮喘可以更快改善肺机械通气参数和血气分析结果,迅速降低细胞因子水平;乳酸盐置换液可以更好地改善CO2潴留.
목적 탐토련속성혈액정화(CBP)치료개선위중효천환자폐궤계통기삼수、세포인자수평、혈기분석결과적궤제.비교응용탄산경염치환액여유산염치환액재이상방면적차별.방법 26례위중효천환자안수궤수자표법분위대조조(10례)、탄산경염CBP조(8례)、유산염CBP조(8례),분별응용단순궤계통기、궤계통기+탄산경염치환액CBP、궤계통기+유산염치환액CBP치료24 h,비교3충치료방법대폐궤계통기삼수、혈청세포인자、혈기분석、동맥혈유산、전해질적영향.결과 탄산양염CBP조、유산염CBP조치료24h후폐궤계통기삼수개선,세포인자수평하강,pH치급양분압득도개선；량충치환액대혈청전해질、동맥혈양분압(PaO2)、동맥혈유산무명현영향.유산염CBP조pH치명현고우탄산경염CBP조(7.39±0.05비7.30±0.01,P＜0.01),동맥혈이양화탄분압(PaCO2,mm Hg,1 mm Hg=0.133 kPa)명현저우탄산경염CBP조(57.14±5.04비89.00±3.66,P＜0.01).결론 연합응용CBP치료위중효천가이경쾌개선폐궤계통기삼수화혈기분석결과,신속강저세포인자수평;유산염치환액가이경호지개선CO2저류.
Objective To explore the mechanism that continuous blood purification (CBP) improve the lung mechanical ventilation parameters,cytokine levels and blood gas analysis results in severe asthma patients,and compare the differences in those parameters between bicarbonate and lactate displacement liquid.Methods According to the random number table,26 severe asthma patients were allocated into control group (n=10),bicarbonate group (n =8) and lactate group (n =8).Twenty-four hours treatment with mechanical ventilation (control group),mechanical ventilation + CBP (bicarbonate grfoup) or mechanical ventilation + CBP (lactate group) were conducted respectively Lung mechanical ventilation parameters,serum cytokine level and blood gas analysis results,arterial blood lactate,and electrolytes level were compared among groups.Results After 24-hour CBP,the lung mechanical ventilation parameters were improved,cytokine levels were decreased,and pH value and partial pressure of oxygen were improved in bicarbonate group and lactate group.The two kinds of displacement liquid had no influence in arterial partial pressure of oxygen (PaO2),arterial blood lactate,and serum electrolytes level.The pH value in lactate group was higher than that in bicadbonate group (7.39 ± 0.05 vs.7.30 ± 0.01,P＜0.01).The arterial partial pressure of carbon dioxide (PaCO2,mm Hg,1 mm Hg=0.133 kPa) was lower in lactate group than that in bicarbonate group (57.14 ± 5.04 vs.89.00 ±3.66,P＜0.01).Conclusions Combine CBP might improve the lung mechanical ventilation parameter,cytokine level and blood gas analysis more quickly in severe asthma treatment.The lactate displacement liquid improves the retention of carbon dioxide more.