连续性静脉-静脉血液滤过联合机械通气治疗ARDS的临床观察

Continuous venovenous hemofiltration(CVVH) combined with mechanical ventilation in patients with acute respiratory distress syndrome(ARDS)

目的 观察连续性静脉 -静脉血液滤过 (CVVH)联合机械通气治疗ARDS患者的临床疗效。方法 选择入住ICU符合ARDS诊断标准的患者 4 0例 ,随机分为 2组 :A组 2 1例 ,采用常规治疗 +机械通气 ;B组 1 9例 ,采用常规治疗 +机械通气 +CVVH。分别观察 2组患者在使用呼吸机时间、氧合指数、吸入氧浓度、动脉血氧分压、PEEP水平、心率、血压及病死率等方面的差别。结果 A、B两组患者在病因、年龄、性别、APACHEⅡ评分及平均脏器功能障碍数等方面相似 ,B组患者加用CVVH后 ,各项指标经统计学处理显示 :病死率 ,B组与A组比较 ,差异有显著性意义 (P <0 0 5 ) :其他指标与A组比较 ,差异均有高度显著性意义 (P <0 0 1 )。结论 CVVH疗法可有效清除ARDS患者血管外肺水和各种应激激素、致炎介质 ,明显改善了ARDS患者肺部氧合功能及血流动力学指标 。

Objective To studye the clinical effects of CVVH combined mechanical ventilation in patients with ARDS.Methods 40 patients fulfilliry ARDS diagnostic criteria were randomized into 2 groups. 21 patients(A group)received routine therapy +mecharical, ventilation. 19 patients(B group)received routine therapy + mechanical ventilation+CVVH.Difference between A and B groups in mechanical ventilation time, oxygenation,inspired oxygen concentration, artery partial pressure of oxygen, PEEP level, heart rate, blood pressure and mortality were measured.Results Patients in both groups were matched in cause of disease,age,sex,Apache II score,and number of organs, After CVVH therapy,patients in group B had lower fatality( P <0 05) and highly significant difference in other indices compared with patients in group A( P <0 01).Conclusion CVVH therapy could actively remove extravascular lung water (EVLW) and various stress hormone and inflammatory mediators and markedly improved oxygenation and hemodynamics of patients with ARDS,raising the success rate of resuscitation.