持续血液净化联合乌司他丁治疗急性呼吸窘迫综合征患者的临床观察

Clinical observation of continuous blood purification combined with ulinastatin in the treatment of acute respiratory distress syndrome

目的探讨持续血液净化联合乌司他丁对急性呼吸窘迫综合征患者治疗效果的影响。方法选取74例急性呼吸窘迫综合征患者,依据随机数字表法随机分为观察组与对照组各37例。对照组在常规处理基础上采用持续血液净化治疗,观察组在对照组基础上联合乌司他丁治疗。比较两组机械通气时间和住重症监护病房(intensive care unit,ICU)时间,治疗前后平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、氧合指数(oxygenation index,PaO2/FiO2)、肺血管通透性指数(pulmonary vascular permeability index,PVPI)、血管外肺水指数(extravascular pulmonary water index,EVLWI)及炎症介质变化。结果观察组机械通气时间和住ICU时间均短于对照组,观察组治疗后MVP、CVP和PaCO2均低于对照组、PaO2/FiO2和PaO2高于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组PVPI、EVLWI、IL-6、人细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)和TNF-α水平均低于对照组,差异均有统计学意义(P<0.05)。结论持续血液净化联合乌司他丁可缩短急性呼吸窘迫综合征患者机械通气时间、住ICU时间,改善血流动力学、血气分析和血管内皮通透性,减轻炎症反应。

To investigate the effect of continuous blood purification combined with ulinastatin on the treatment of acute respiratory distress syndrome(ARDS)patients.Methods A total of 74 patients with ARDS were randomly divided into the observation group(37 cases)and the control group(37 cases)according to the random number table method.The patients in the control group were treated with continuous blood purification,while the patients in the observation group were treated with continuous blood purification combined with ulinastatin.The duration of mechanical ventilation and intensive care unit(ICU)stay were compared between the two groups,together with the comparison on the mean arterial pressure(MAP),central venous pressure(CVP),Oxygenation Index(PaO2/FiO2),pulmonary vascular permeability index(PVPI),extravascular pulmonary water index(EVLWI)and inflammatory mediators before and after treatment.Results The duration of mechanical ventilation and ICU stay of the observation group were shorter than those of the control group(P<0.05).After treatment,there was a lower MVP and CVP and higher PaO2/FiO2 and PaO2 in the observation group than those of the control group(P<0.05),meanwhile the levels of PVPI,EVLWI,interleukin-6(IL-6),intercellular adhesion molecule-1(ICAM-1)and tumor necrosis factor-α(TNF-α)of the observation group were lower than those of the control group,and all the differences were statistically significant(P<0.05).Conclusions Continuous blood purification combined with ulinastatin may shorten the duration of mechanical ventilation and ICU stay in patients with ARDS,it can also improve hemodynamics and endothelial permeability,and reduce the inflammatory response.