高置换率和低置换率CRRT对急性重症胰腺炎并发急性呼吸窘迫综合症患者呼吸循环的影响

Effects of continuous renal replacement therapy with different replacement rates on respiration and blood circulation in the patients with severe acute pancreatitis complicated by acute respiratory distress syndrome

目的观察高置换率和低置换率连续性肾脏替代治疗(CRRT)对重症胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)时呼吸循环及外周血TNF-α水平的影响.方法回顾性分析2001年以来在我院接受治疗的SAP合并ARDS、并接受呼吸机和CRRT治疗的患者,共22例.按每位患者接受CRRT置管率的不同分为2组A组(10例,CRRT置换率为2L/h),B组(12例,CRRT置换率为4L/h).记录给予CRRT治疗前、治疗后6,12,24h的实测呼吸频率、心率和无创动脉血压;于上述相应时点抽取动脉血做动脉血气分析,并留取血样,使用ELISA法测定血清TNF-α水平.结果CRRT后两组患者的氧合指数和呼吸均有明显的改善(与治疗前比较,P<0.01),血压、心率也趋于稳定(与治疗前比较,P<0.05或<0.01),其中B组的变化更为显著(与A组比较,P<0.05或<0.01);CRRT后两组患者的外周血TNF-α水平均有明显降低(与治疗前比较,P<0.01),其中B组患者血TNF-α水平的改变更为显著(与A组比较,P<0.01).结论高置换率CRRT能较低置换率CRRT更有效地清除SAP合并ARDS患者体内的炎症因子,因而更有利于其呼吸循环功能的改善.

AIM： To observe the effects of continuous renal replacement therapy （CRRT） with low or high replacement rate on the respiration and blood circulation as well as peripheral blood TNF-α level in the patients with severe acute pancreatitis （SAP） complicated by acute respiratory distress syndrome （ARDS）. METHODS： Twenty-two patients with SAP complicated by ARDS, who had been admitted into ICU of our hospital since 2001 and were treated with respirator and CRRT, were retrospectively studied. And they were divided into 2 groups according to the difference in the replacement rate of CRRT used, namely Group A having 10 cases with the replacement rate of 2 L/h during CRRT, and Group B having 12 cases with the replacement rate of 4 L/h. The measured respiratory rate, heart rate and noninvasive blood pressure were recorded at the time before CRRT and 6, 12, 24 h after CRRT, and arterial blood was sampled at the above times for arterial blood gas analysis, and 2 mL of blood sample was kept for determining TNF-α level by ELISA method.RESULTS： Just after CRRT, the oxygenation index improved and the measured respiratory rate decreased in the patients from both groups （P 〈0.01 vs before CRRT）, and the systolic blood pressure, diastolic blood pressure and heart rate also decreased （P 〈0.05 or 0.01 vs before CRRT）, and the peripheral blood TNF-α level also decreased （P 〈0.01 vs before CRRT）, and the changes in the above indices were more marked in the patients from Group B than those in the patients from Group A （P 〈 0.05 or0.01 ）. CONCLUSION： CRRT with high replacement rate could benefit the removal of TNF-α from the body more significantly than that of low replacement rate did, thus benefiting the stability of the respiration and blood circulation in the patients with SAP complicated by ARDS.