CAJ | 학술논문

目的探讨连续性高容量血液滤过(CHVHF)治疗重度急性呼吸窘迫综合征(ARDS)的临床疗效.方法采用前瞻性随机对照研究方法,选择2007年6月至2011年6月入住本院重症监护病房(ICU)的65例重度ARDS患者进行研究,按照随机数字表法分为治疗组(37例)和对照组(28例),对照组给予常规治疗,治疗组在常规治疗基础上应用CHVHF治疗.观察两组患者治疗前及治疗后6、24、48、72 h肺功能指标氧合指数(PaO2/FiO2)、血管外肺水指数(EVLWI)、动脉血二氧化碳分压(PaCO2),以及血流动力学参数如心率(HR)、平均动脉压(MAP)的变化,并观察机械通气的持续时间、住ICU天数、撤机成功率、28 d存活率等指标.结果两组治疗后肺功能指标较治疗前均有明显改善,随治疗时间延长PaO2/FiO2(mm Hg,1 mm Hg=0.133kPa)逐渐升高,EVLWI (ml/kg)、PaCO2(mm Hg)逐渐下降,且治疗组较对照组改善明显(6 h PaO2/FiO2:92.6±7.2比83.8±11.4,24 h EVLWI:10.8±3.7比12.6±4.5,24 h PaCO2:47.2±8.5比51.4±4.8,均P＜0.05).两组治疗后血流动力学指标HR、MAP较治疗前明显改善,但两组间比较差异无统计学意义.与对照组比较,治疗组机械通气时间(d)、住ICU天数(d)明显缩短(机械通气时间:12±4比19±6,住ICU天数:21±4比33±8,均P＜0.05),撤机成功率、28 d存活率明显升高(撤机成功率:81.1％比64.3％,28 d存活率:86.5％比71.4％,均P＜0.05).结论重度ARDS患者采用CHVHF治疗能明显改善肺功能,缩短机械通气时间,提高机械通气撤机成功率,降低病死率,对血流动力学无明显不利影响.
목적 탐토련속성고용량혈액려과(CHVHF)치료중도급성호흡군박종합정(ARDS)적림상료효.방법 채용전첨성수궤대조연구방법,선택2007년6월지2011년6월입주본원중증감호병방(ICU)적65례중도ARDS환자진행연구,안조수궤수자표법분위치료조(37례)화대조조(28례),대조조급여상규치료,치료조재상규치료기출상응용CHVHF치료.관찰량조환자치료전급치료후6、24、48、72 h폐공능지표양합지수(PaO2/FiO2)、혈관외폐수지수(EVLWI)、동맥혈이양화탄분압(PaCO2),이급혈류동역학삼수여심솔(HR)、평균동맥압(MAP)적변화,병관찰궤계통기적지속시간、주ICU천수、철궤성공솔、28 d존활솔등지표.결과 량조치료후폐공능지표교치료전균유명현개선,수치료시간연장PaO2/FiO2(mm Hg,1 mm Hg=0.133kPa)축점승고,EVLWI (ml/kg)、PaCO2(mm Hg)축점하강,차치료조교대조조개선명현(6 h PaO2/FiO2:92.6±7.2비83.8±11.4,24 h EVLWI:10.8±3.7비12.6±4.5,24 h PaCO2:47.2±8.5비51.4±4.8,균P＜0.05).량조치료후혈류동역학지표HR、MAP교치료전명현개선,단량조간비교차이무통계학의의.여대조조비교,치료조궤계통기시간(d)、주ICU천수(d)명현축단(궤계통기시간:12±4비19±6,주ICU천수:21±4비33±8,균P＜0.05),철궤성공솔、28 d존활솔명현승고(철궤성공솔:81.1％비64.3％,28 d존활솔:86.5％비71.4％,균P＜0.05).결론 중도ARDS환자채용CHVHF치료능명현개선폐공능,축단궤계통기시간,제고궤계통기철궤성공솔,강저병사솔,대혈류동역학무명현불리영향.
Objective To investigate the effect of continuous high-volume hemofiltration (CHVHF) in patients with severe acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted.Sixty-five patients with severe ARDS admitted to intensive care unit (ICU) from June 2007 to June 2011were divided into control group (n=28) and treatment group (n=37).Patients in treatment group were treated with CHVHF and other routine treatments.Patients in control group received routine treatments only.The oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI),arterial partial pressure of carbon dioxide (PaCO2),heart rate (HR),mean arterial pressure (MAP) were compared between control group and treatment group before and 6,24,48,72 hours after treatment.The duration of mechanical ventilation (MV),ICU stay time,percentage of weaning from MV,and 28-day survival rate were also compared.Results The indexes of pulmonary function were improved after treatment in both groups.With prolonged time of treatment,PaO2/FiO2 (mm Hg,1 mm Hg=0.133 kPa) was elevated,and EVLWI (ml/kg),PaCO2 (mm Hg) were lowered,and the improvements were more marked in treatment group compared with control group (6-hour PaO2/FiO2:92.6 ± 7.2 vs.83.8 ± 11.4,24-hour EVLWI:10.8 ± 3.7 vs.12.6 ±4.5,24-hour PaCO2:47.2 ± 8.5 vs.51.4 ± 4.8,all P＜0.05).HR and MAP were improved after the treatment in both groups,and there was no significant difference between groups.Compared with control group,the duration of MV (days) and ICU stay (days) were shortened in treatment group (duration of MV:12 ±4 vs.19 ±6,ICU stay time:21±4 vs.33 ± 8,both P＜0.05),and percentage of successful weaning from MV and 28-day survival rate were higher in treatment group (percentage of successful weaning from MV:81.1％ vs.64.3％,28-day survival rate:86.5％ vs.71.4％,both P＜0.05).Conclusions CHVHF is an effective adjuvant treatment for severe ARDS.It can improve the lung function,shorten the duration of MV,improve the percentage of successful weaning from MV,and the survival rate,and it lowers the mortality,but it imparts no obvious influence to hemodynamics in patients.