连续性静脉-静脉血液滤过治疗ARDS的效果观察

Effect of continuous veno-venous hemofiltration in treatment of acute respiratory distress syndrome

目的：探讨床旁连续性静脉-静脉血液滤过（CVVH）治疗急性呼吸窘迫综合征（ARDS）的效果。方法选取本院2011年5月~2013年5月收治的ARDS患者58例，将其分为对照组（26例）和CVVH组（32例），对照组仅应用基础方案治疗，CVVH组在基础方案基础上，早期介入CVVH治疗。观察两组患者治疗前后的病情变化，监测治疗前后血气、血清C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平及APACHEⅡ评分并进行分析。结果与对照组比较，CVVH组治疗后血肌酐明显降低，APACHEⅡ评分下降（P〈0.05）；CVVH组治疗后血HCO3-、氧饱和度及氧分压较对照组增高明显（P〈0.05）；与对照组比较，CVVH组治疗后CRP及TNF-α均显著下降（P〈0.01）；CVVH组半年生存率明显高于对照组（65.62%vs46.15%）（P〈0.05）。结论CVVH治疗ARDS患者，能有效纠正氧合指数及APACHEⅡ评分，加强炎症因子的清除，改善预后。

Objective To investigate the clinical effect of continuous veno-venous hemofiltration （CVVH） in the treat-ment of acute respiratory distress syndrome （ARDS）. Methods 58 cases of patients with ARDS in our hospital from May 2011 to May 2013 were selected,and were randomly divided into control group （n=26） and CVVH group （n=32）,pa-tients in control group were treated with basic therapy,while patients in CVVH group were treated with basic therapy combined with CVVH early.The condition changes before and after treatment were observed,blood gas analysis were monitored and serum levels of C-reactive protein （CRP）,tumor necrosis factor-α（TNF-α） were measured and APACHEII scores were analyzed. Results Compared with control group,serum creatinine and APACHE II score decreased in CVVH group （P〈0.05）;blood HCO3-,oxygen saturation and oxygen partial pressure increased significantly in CVVH group compared with that in control group （P〈0.05）;after CVVH treatment,CRP and TNF-αwere significantly decreased （P〈0.01）.Half year survival rate in CVVH group was higher than that in control group （65.62% vs 46.15%） （P〈0.05）. Conclusion CVVH treatment for ARDS patients can effectively improve oxygenation index and APACHE II score, strengthen eliminating of inflammation factors and improve the prognosis.