血液净化联合抗菌药物对ARDS合并肺部感染患者EVLWI及PCT的影响

Effect of blood purification combined with antibiotics on extravascular lung water index and procalcitonin of acute respiratory distress syndrome patients complicated with pulmonary infection

目的分析血液净化联合抗菌药物对急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)合并肺部感染患者血管外肺水指数(extravascular lung water index,EVLWI)及血清降钙素原(procalcitonin,PCT)水平的影响。方法选择2015年4月-2018年9月广西医科大学附属柳铁中心医院ICU收治的ARDS合并肺部感染患者37例,对患者肺部感染病原菌进行分离鉴定,给予相应的抗菌药物治疗,同时给予患者连续性血液净化(CBP)治疗。比较CBP治疗0 h、6 h、12 h、24 h、48 h时EVLWI、氧合指数、中心静脉压、PCT、APACHEⅡ评分及炎性指标变化情况。结果 37例ARDS合并肺部感染患者共分离病原菌48株,其中革兰阴性菌32株(66.67%)、革兰阳性菌11株(22.92%)、真菌5株(10.42%)。随着治疗时间的延长,患者EVLWI以及中心静脉压逐渐降低(P<0.05),而氧合指数逐渐升高(P<0.05)。随着治疗时间的延长,患者PCT、APACHEⅡ评分以及CRP、IL-6水平逐渐降低(P<0.05)。采用Spearsman相关性分析,结果显示, EVLWI、PCT与患者APACHEⅡ评分呈显正相关关系(r=0.428,0.411,P<0.05)。结论连续性血液净化联合抗菌药物治疗急性呼吸窘迫综合征合并肺部感染,可有效降低患者血管外肺水指数及血清降钙素原水平,同时显著降低机体炎症反应,值得临床推广运用。

OBJECTIVE To observe the effect of blood purification combined with antibiotics on extravascular lung water index(EVLWI) and procalcitonin(PCT)of acute respiratory distress syndrome(ARDS) patients complicated with pulmonary infection. METHODS A total of 37 ARDS patients complicated with pulmonary infection who were treated in ICU of Liutie Central Hospital Affiliated to Guangxi Medical University from Apr 2015 to Sep 2018 were enrolled in the study, the pathogens that were isolated from the patients with pulmonary infection were identified and given antibiotic therapy as well as continuous blood purification(CBP).EVLWI, oxygenation index, central venous pressure, PCT, APACHE Ⅱ score and inflammatory indexes were observed and compared after CBP for 0, 6, 12, 24 and 48 hours. RESULTS Totally 48 strains of pathogens were isolated from the 37 ARDS patients complicated with pulmonary infection, 32(66.67%) of which were gram-negative bacteria, 11(22.92%) were gram-positive bacteria, and 5(10.42%) were fungi.The EVLWI and central venous pressure were decreased step by step with the treatment time(P<0.05), while the oxygenation index was increased(P<0.05).The levels of PCT,CRP and IL-6 as well as APACHE Ⅱ score of the patients were decreased gradually with the treatment time(P<0.05).Spearsman correlation analysis showed that the EVLWI and PCT were positively correlated with the APACHE Ⅱ score(r=0.428,0.411,P<0.05). CONCLUSION CBP combined with antibiotics can effectively reduce the EVLWI and serum PCT level of the ARDS patients complicated with pulmonary infection and remarkably reduce the inflammatory reactions, and it is worthy to be promoted in the hospital.