连续性静脉-静脉血液滤过治疗高龄ARDS伴高钠血症的疗效观察

Effect observation on the hypernatremia in elderly patients with ARDS treated by continuous veno-venous hemofiltration

目的探讨床旁连续性静脉-静脉血液滤过(CVVH)治疗高龄呼吸窘迫综合征(ARDS)伴高钠血症的疗效。方法对18例高龄ARDS伴高钠血症患者进行床旁CVVH治疗,动态观察患者的血钠浓度及调整置换液成分,记录肾功能、血气指标、血浆渗透压变化及APACHEⅡ评分并进行分析。结果治疗后血浆渗透压较治疗前下降[(318.5±20.2)mmol/L vs.(294.4±15.1)mmol/L,P<0.01];治疗后氧合指数治疗前上升[(157.4±34.2)vs.(178.4±40.4),P<0.05],APACHEⅡ评分较治疗前下降[(20.8±9.4)分vs.(14.5±8.8)分,P<0.05],前后比较差异有统计学意义。结论 CVVH治疗高龄ARDS伴高钠血症患者,能有效纠正高钠血症,改善氧合指数及APACHEⅡ评分。

Objective To investigate the clinical effects on the hypernatremia in elderly patients with ARDS treated by continu- ous veno-venous hemofihration（CVVH）. Methods Eighteen cases of elderly patients with ARDS and hypernatremia were treated by CVVH, the serum sodium concentration was observed and the displacement fluid composition was adjusted dynamically by serum sodium concentration, the changes of kidney function, gas index, plasma osmotic pressure and APACHE Ⅱ score were recorded and analyzed. Results After treatment, the plasma osmotic pressure of patients declined[（318.5±20.2）mmol/L vs. （294. 4± 15. 1） mmol/L,P〈0.01]. After treatment, the oxygenation index rised[（157.4 ± 34.2） vs. （178.4 ± 40.4）, P〈0.05], APACHE Ⅱ score declined[（20.8± 9.4） vs. （14.5 ±8.8） ,P〈0.05] ,and the comparison of after and before treatment was statistically signifi- cant. Conclusion Therapy method of elderly patients with ARDS and hypernatremia treated by CVVH can correct hypernatremia, improve oxygenation index and APACHE Ⅱ score effectively.