连续性血液净化治疗重症肺炎合并多器官功能衰竭患者的效果

Observation on the Effect of Continuous Blood Purification in the Treatment of Patients with Severe Pneumonia Complicated with Multiple-Organ Failure

目的观察连续性血液净化对重症肺炎合并多器官功能衰竭患者的治疗效果。方法选取2013年1月至2015年1月兵器工业卫生研究所收治的重症肺炎合并多器官功能衰竭患者68例。按照随机数字表法分为观察组和对照组，各34例。对照组采用常规治疗，包括吸氧、利尿、强心、镇静等治疗，观察组在此基础上加以连续性血液净化，治疗的时间持续在5—20d。比较治疗前和治疗5d后的肾功能指标[血肌酐（SCr）、血尿素氮（BUN）]、血气指标[pH值、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）]，生命体征[呼吸频率、心率、血压]。观察两组患者的临床症状消失时间（咳嗽改善时间、心率减慢时间及水肿消失时间）和临床疗效。结果治疗后，观察组SCr、BUN显著低于对照组[（178±15）μmol／L比（278±20）μmol／L，（14．9±2．4）μmol／L比（22．6±3．8）mmol／L]，pH值、PaO2、SaO2显著高于对照组[（7．9±0．9）比（7．3±0．9）、（89±12）mmHg（1mmHg=0．133kPa）比（71±10）mmHg、0．95±0．03比0．82±0．02]，差异有统计学意义（P〈0．05）。治疗后，观察组患者呼吸频率、心率低于对照组[（18±3）次／min比（25±4）次／min、（89±8）次／min比（96±10）次／min]，平均动脉压和24h尿量高于对照组[（83．8±14．2）mmHg比（73．4±12．3）mmHg、（1346±64）mL比（835±56）mL]，差异有统计学意义（P〈0．05）。观察组患者总的疗效率高于对照组[88．24％（30／34）比67．65％（23／34）]（P〈0．05）。观察组患者的咳嗽改善时间、心率减慢时间及水肿消失时间短于对照组[（3．0±0．6）d比（5．6±1．3）d、（7．3±1．2）d比（10．2±1．7）d、（4．5±0．4）d比（6．9±1．2）d]，差异有统计学意义（P〈0．01）。结论重症肺炎合并多器官功能衰竭患者采用连续性血液净化治疗，能显著改善患者的肾功能、动脉血气指标、生命体征等情况，可缩短患者的临床症状改善时间，临床疗效良好。

Objective To study the continuous blood purification effect for the treatment of patients with severe pneumonia complicated with multiple-organ failure. Methods Total of 68 patients with severe pneumonia complicated with multiple-organ failure in 521 Hospital of NORINCO Group from Jan. 2013 to January 2015 were included in the study. According to the random number table method they were divided into an observation group and a control group,34 eases in each group. The control group was treated with conventional methods,including oxygen inhalation, diuresis, cardiatonic and sedation, the observation group was added with continuous blood purification, and the treatment lasted 5-20 d. The renal index [ serum croatinine （Scr） , blood urea nitrogen （BUN） ] , blood gas index [ pH, arterial blood oxygen partial pressure （PaO2 ） , arterial blood oxygen saturation （SaO2 ） ], vital signs （heart rate, blood pressure, respiratory frequency） before treatment and after 5 d of treatment were compared. The clinical symptoms disappearing time （ cough improvement, heart rate slowing down and edema disappearing） and the clinical curative effect of the two groups were observed. Results After treatment, Scr, BUN of the observation group was obviously lower than the control group [（178±15）μmol/L vs （278±20） μmol/L, （14.9 ± 2.4） mmol/L vs （22.6 ± 3.8） mmol/L], pH, PaO2 ,SaO2 were significantly higher than the control group[ （7.9 ±0. 9） vs （7.3± 0. 9）, （89±12） mmHg vs （71 ±10） mmHg,0. 95 ±0. 03 vs 0. 82±0. 02] （ P 〈0. 05 ）. After treatment, the respiratory frequency and heart rate in the observation group were lower than the control group[ （18 ±3 ） times/rain vs （25±4） times/min, （89±8 ） times/rain vs （96 ± 10 ） times/min] , mean arterial pressure and 24 h urine volume were higher than the control group [ （ 83.8 ± 14.2 ） mmHg vs （ 73.4± 12. 3 ） mmHg, （ 1346 ± 64） mL vs （ 835 ± 56） mL ], with statistically significant difference（ P 〈 0. 05 ）. The total efficacy of the observation group was higher than the control group [ 88.24% （30/34） vs 67.65 % （23/ 34 ） 1 （ P 〈0. 05 ）. The cough improving time, heart rate slow down time and edema disappearing time of the observation group were shorter than the control group[ （3.0±0. 6） d vs （5.6 ± 1.3） d, （7.3± 1.2） d vs （ 10. 2 ±1.7 ） d, （4.5 ± 0. 4） d vs （ 6.9± 1.2 ） d ] , with statistically significant differences （ P 〈 0. 05 ）. Conclusion The continuous blood purification treatment for patients with severe pneumonia complicated with multiple-organ failure can significantly improve the patient＇s kidney function, arterial blood gas index, vita2 signs, ere, , and can shorten the patient＇s clinical symptoms improvement time,with good clinical curative effect.