持续静静脉血液滤过对甲型H1N1流感呼吸衰竭患者氧代谢及血管外肺水的影响

The effects of continuous veno-venous hemofiltration on oxygen metabolism and thoracic fluid content in alpha H1N1 influenza virus infected patients complicated with respiratory failure

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24h、48h、72h、120h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)],24h、48h、72h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,48h后HR、TFC和72h的SVR、PVR均明显下降,CO、PAWP及MPAP在120h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,48h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DO2、ERO2、VO2均明显增高,同时伴有动脉血氧分压的下降,CVVH治疗72h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 72h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。

Objective To study the effects of continuous veno-venous hemofiltration（CVVH） on oxygen metabolism and thoracic fluid content（TFC） in H1N1 influenza virus infected patients with respiratory failure.Methods We recruited 10 H1N1 influenza virus infected patients with respirator failure,to whom CVVH was applied in combination with other routine therapies.Their hemodynamic parameters including heart rate（HR）,mean pulmonary artery pressure（MPAP）,pulmonary artery wedge pressure（PAWP）,peripheral vascular resistance（SVR）,pulmonary vascular resistance（PVR）,cardiac output（CO）,and TFC were measured before CVVH and after CVVH for 24h,48h,72h and 120h.Oxygen delivery（DO2）,oxygen extraction（VO2）,oxygen extraction rate（ERO2）,and acute physiology and chronic health evaluation（APACHE II） were also examined before CVVH and after CVVH for 24h,48h and 72h.Results HR and TFC decreased after CVVH for 48h,SVR and PVR declined after CVVH for 72h,and CO,PAWP and MPAP gradually stabilized after CVVH for 120h.The changes of these parameters are statistically significant as compared with those before CVVH（P0.05）.TFC reduced after CVVH for 48h（P0.05,compared with that before CVVH）.In patients before CVVH,DO2,ERO2 and VO2 increased,and oxygen partial pressure in pulmonary artery（PaO2） decreased.After CVVH for 72h,their DO2,ERO2 and VO2 gradually stabilized in association with the increases of oxygenation index（OI） and PaO2 and the decrease of APACHE II scores（P0.05）.Conclusion CVVH can significantly improve respiratory function and oxygen metabolism,remove extravascular water in lung,and thus raise the survival rate of the patients.