连续性血液净化对肺外源性急性呼吸窘迫综合征患者的影响

Effect of continuous blood purification in the treatment of extrapulmonary acute respiratory distresssyndrome

目的观察连续性血液净化对肺外源性急性呼吸窘迫综合征（ARDS）患者的影响。方法将因肺外源性病因引起的ARDS患者46例完全随机分为2组：观察组（n=26）常规治疗外给予连续性血液净化联合机械通气；对照组（n=20）常规治疗外给予机械通气。观察2组治疗前及治疗后第1、3天的急性生理和慢性健康评分（APACHEⅡ）、血浆高敏c反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、氧合指数及机械通气时间。结果观察组治疗后第1、3天hs-CRP[对照组分别为（102±22）、（64±17）mg／L比（138±29）mg／L，观察组分别为（126±21）、（118±18）mg／L比（132±28）mg／L]、IL-6[对照组分别为（16-±5）、（13±4）μg／L比（24±7）μg／L，观察组分别为（24±6）、（22±4）μg／L比（25±7）μg／L]、TNF-α）[对照组分别为（402±25）、（286±17）ng／L比（506±30）ng／L，观察组分别为（498±29）、（468±26）ng／L比（502±30）ng／L]的下降及动脉血氧合指数的改善明显优于治疗前，亦优于对照组同时点；2组治疗后第1、3天APACHEⅡ分值[对照组分别为（26±6）、（22±5）分比（29±7）分，观察组分别为（22±5）、（18±4）分比（30±7）分，均P〈0．05]及动脉血氧合指数均明显优于治疗前[对照组分别为（186±40）、（220±43）比（170±37），观察组分别为（246±44）、（320±56）比（168±37），均P〈0．05]，观察组在改善程度上明显优于对照组，差异均有统计学意义（均P〈0．05）。观察组机械通气时间明显短于对照组[（4±2）d比（7±3）d，P〈0．05]。结论连续性血液净化能有效清除肺外源性ARDS患者体内炎性递质，改善氧合，缩短机械通气时间。

Objective To evaluate the effect of continuous blood purification （CBP） on serum levels of proinflammatory cytokines and clinical outcome in patients with extrapulmonary acute respiratory distress syndrome （ARDS）. Methods Forty-six patients with a diagnosis of extrapulmonary ARDS were enrolled and randomized into observation group （ n = 26 ） and control group （ n = 20 ）. The patients in control group received conventional treatment including mechanical ventilation, while patients in observation group were treated with continuous blood purification in addition to the routine treatment. The acute physiology and chronic health evaluation （APACHE） Ⅱ score, oxygenation index, and blood levels of high-sensitivity C-reactive protein （hs-CRP） , interleukin-6 （ IL-6 ） and tumor necrosis factor alpha （TNF-α） were measured on baseline, day 1 and day 3 after study enrollment. Moreover, duration of mechanical ventilation was also recorded. Results Compared with control group, patients in observation group experienced significant improvement in APACHE II score and oxygenation index （ P 〈 0. 05 ）. Serum levels of hs-CRP, IL-6 and TNF-α decreased more rapidly in patients with observation group （ P 〈 0. 05 ）. Duration of mechanical ventilation in observation group was much shorter （ P 〈 0. 05 ）. Conclusion In patients with extrapulmonary ARDS, continuous blood purification can improve clinical outcome, possibly secondary to removal of pro-inflammatory mediators.