体外膜肺氧合联合连续性肾脏替代治疗用于急性呼吸窘迫综合征患者的效果

Effect of extracorporeal membrane oxygenation combined with continuous renal replacement therapy on acute respiratory distress syndrome

目的 探讨体外膜肺氧合(ECMO)联合连续性肾脏替代治疗(CRRT)用于急性呼吸窘迫综合征(ARDS)患者的效果。方法 选取郑州大学附属郑州中心医院2018年3月至2022年3月收治的64例ARDS患者进行研究,采用双色球法分为对照组与观察组,每组32例。对照组采用常规治疗,观察组则加CRRT联合ECMO治疗。比较氧合情况,包括呼气末正压(PEEP)值、氧合指数;感染指标,包括血清降钙素原(PCT)、血乳酸值;血流动力学情况,包括心指数(CI)、血管外肺水指数(EVLWI);急性生理与慢性健康评分(APACHEⅡ);机械通气时间及重症监护室(ICU)入住时间。结果 治疗前,两组氧合情况、感染指标、血流动力学情况比较,差异未见统计学意义(P>0.05);治疗后,观察组PEEP值更低、氧合指数更高,PCT、血乳酸值更低,CI更高、EVLWI更低,与对照组比较,差异有统计学意义(P<0.05)。观察组机械通气时间、ICU入住时间更短,差异有统计学意义(P<0.05)。治疗前两组APACHEⅡ比较,差异未见统计学意义(P>0.05);治疗48 h、72 h,观察组APACHEⅡ更低,差异有统计学意义(P<0.05)。结论 ARDS患者采取CRRT联合ECMO治疗,可更好地改善患者的氧合情况、感染指标、血流动力学情况,促使患者整体健康提升,并且缩短机械通气时间、ICU入住时间。

Objective To investigate the effect of extracorporeal membrane oxygenation(ECMO) combined with continuous renal replacement therapy(CRRT) on acute respiratory distress syndrome(ARDS).Methods A study was conducted on 64 patients with ARDS admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2018 to March 2022.The patients were divided into control group and observation group using the dual chromosphere method,with 32 patients in each group.The control group received routine treatment,while the observation group received CRRT combined with ECMO treatment.The oxygenation status,including positive end expiratory pressure(PEEP) value and oxygenation index;Infection indicators,including serum Calcitonin(PCT),blood lactate value;Hemodynamics,including Cardiac index(CI) and extravascular lung water index(EVLWI);APACHE II score;Mechanical ventilation time and ICU check-in time were compsred.Results Before treatment,there was no significant difference in oxygenation,infection index or hemodynamics between the two groups(P<0.05).After treatment,the PEEP value of the observation group was lower,the oxygenation index was higher,the PCT and blood lactic acid values were lower,the CI was higher,the EVLWI was lower than those of the control group(P<0.05).The time of mechanical ventilation and ICU stay in the observation group were shorter,with significant difference(P<0.05).There was no significant difference in APACHE Ⅱ scores between the two groups before treatment(P<0.05),while the scores in the observation group were lower at 48 h and 72 h after treatment(P<0.05).Conclusions CRRT combined with ECMO can better improve the oxygenation,infection index and hemodynamics of patients with ARDS,promote the overall health of patients,and shorten the time of mechanical ventilation and ICU stay.