短时间歇血液滤过对急性呼吸窘迫综合征患者的治疗效果

Efficiency of short time intermittent hemofiltration on acute respiratory distress syndrome

目的研究短时间歇静-静脉血液滤过(SIVVH)对急性呼吸窘迫综合征(ARDS)的治疗效果。方法回顾性选取2014年1月至2016年10月急诊ICU收治的95例ARDS患者,分为SIVVH组和对照组,其中SIVVH组37例,对照组58例,SIVVH组接受常规治疗加SIVVH治疗,对照组接受常规治疗,对比分析两组患者治疗前生命体征、氧合指数、APACHEⅡ评分和治疗后生命体征、氧合指数、APACHEⅡ评分、机械通气时间、ICU住院时间及28 d病死率。结果治疗前两组患者生命体征、氧合指数、APACHEⅡ评分无明显差异(P>0.05)。治疗后24、48、72、120 h SIVVH组患者心率与呼吸较对照组明显降低,差异有统计学意义(P<0.05)。治疗后24、48 h SIVVH组患者体温较对照组明显降低,差异有统计学意义(P<0.05)。治疗后24、48、72、120 h SIVVH组氧合指数较对照组明显升高,差异有统计学意义(P<0.05)。治疗后72、120 h SIVVH组APACHEⅡ评分较对照组明显降低,差异有统计学意义(P<0.05)。SIVVH组机械通气时间及ICU住院时间较对照组明显缩短,差异有统计学意义(P<0.05)。SIVVH组28 d死亡率较对照组无明显下降,差异无统计学意义(P>0.05)。结论 SIVVH治疗能促进ARDS患者肺功能的恢复,减少机械通气时间,缩短ICU住院天数,可能成为一项重要的辅助治疗措施。

Objective To research the efficiency of short time intermittent veno-venous hemofiltration（SIVVH）on acute respiratory distress syndrome（ARDS）. Methods Totally 95 patients suffered ARDS betweenJanuary 2014 and October 2016 in the emergency intensive care unit（EICU）were divided to SIVVH group（n =37）and control group（n = 58）. The SIVVH group received traditional therapy and SIVVH therapy,and controlgroup traditional therapy. Vital signs,oxygenation index,APACHEⅡ scores between two groups before the treat-ment were compared. Vital signs,oxygenation index,APACHEⅡ scores,time of mechanical ventilation,lengthof stay of EICU and 28 day mortality between two groups after the treatment were compared. Results In twogroups,vital signs,oxygenation index and APACHEⅡ scores before the treatment showed no significant difference（P 0.05）. In SIVVH group,heart rate and respiratory frequency on the 24 th,48 th,72 ndand 120 thhour weredescended significantly when compared with those in control group（P 0.05）;body temperature on the 24 thand48 thhour were descended obviously when compared with those in control group（P 0.05）;the oxygenation indexon the 24 th,48 th,72 ndand 120 thhour were raised（P 0.05）;APACHEⅡ scores on the 72 ndand 120 thhour werelower than those in control group（P 0.05）. There were shorter time of mechanical ventilation and length of stay ofICU in SIVVH group when compared with control group（P 0.05）,but the 28 day mortality in SIVVH group wasnot lower when compared with that in control group（P 0.05）. Conclusions SIVVH can improve the function oflung in ARDS,decrease the time of mechanical ventilation and the length of stay of ICU,and possible becomes animportant adjunctive therapy.