血浆置换治疗急性呼吸窘迫综合征有效性的探索性随机对照研究

Clinical application of therapeutic plasma exchange in acute respiratory distress syndrome

目的探讨血浆置换在急性呼吸窘迫综合征(ARDS)治疗中的临床有效性。方法本研究为前瞻性随机平行对照研究,将郴州市第一人民医院重症医学科中符合纳入标准的42例患者随机分为对照组及血浆置换组。对照组患者采取常规治疗;血浆置换组患者在采取常规治疗的同时接受血浆置换治疗。比较分析两组患者机械通气时间、重症监护室(ICU)住院时间、28 d病死率及90 d病死率、治疗前后氧合指数、序贯器官衰竭估计评分(SOFA评分)、去甲肾上腺素(NE)使用剂量、C反应蛋白(CRP)、降钙素原(PCT)及白细胞介素6(IL-6)水平。结果组内比较,对照组患者治疗后氧合指数、IL-6、PCT及CRP水平较治疗前显著改善(t=-4.50、2.46、Z=-3.53、t=5.55,均P<0.05),治疗前后SOFA评分及NE使用剂量差异无统计学意义(t=1.98,Z=-0.47,均P>0.05);血浆置换组患者治疗后氧合指数、SOFA评分、IL-6、PCT、CRP水平及NE使用剂量较治疗前均显著改善(t=2.18、9.23、5.26、Z=-3.77、t=7.27、Z=-2.54,均P<0.05)。组间比较,治疗后血浆置换组患者氧合指数、SOFA评分、IL-6、CRP水平及NE使用剂量较对照组患者均显著改善(t=2.18、-2.21、-2.12、-2.61、Z=-2.11,均P<0.05);与对照组比较,血浆置换组患者机械通气时间[(14.0±5.2)d比(18.4±6.3)d]、ICU住院时间[(19.3±4.9)d比(23.2±7.3)d]及28 d病死率[14.3%(3/21)比42.8%(10/21)]均显著下降(t=-2.48、-2.04、χ^(2)=4.20,均P<0.05),两组患者90 d病死率比较差异无统计学意义[28.6%(6/21)比52.4%(11/21),χ^(2)=2.47,P=0.208]。结论血浆置换治疗可以减轻ARDS患者炎症反应,改善器官功能,降低患者短期病死率。

Objective To investigate the efficacy of plasma exchange(PE)in treatment of patients with acute respiratory distress syndrome(ARDS).Methods Forty-two patients who met the inclusion criteria in the intensive care unit of Chenzhou First People′s Hospital were randomly divided into control group and plasma exchange(PE)group with 21 cases in each group.The control group received conventional treatment;while the PE group received conventional treatment plus PE.The mechanical ventilation time(MVT),length of ICU stay(ICU LOS),28-day mortality and 90-day mortality of patients were analyzed.The oxygenation index,SOFA score,norepinephrine(NE)dose,C-reactive protein(CRP),procalcitonin(PCT)and IL-6 levels were evaluated before and after treatment.Results In the control group the oxygenation index,IL-6,PCT and CRP were significantly improved after treatment(t=-4.50,2.46,Z=-3.53,t=5.55,all P<0.05),but the SOFA score and NE dose were not significantly changed(t=1.98,Z=-0.47,all P>0.05).In the PE group,the oxygenation index,SOFA score,IL-6,PCT,CRP were significantly improved and the NE dose was reduced after treatment(t=2.18,9.23,5.26,Z=-3.77,t=7.27 and Z=-2.54,all P<0.05).The oxygenation index,SOFA score,IL-6,CRP were significantly better after treatment and NE dose was lower in PE group than those in the control group(t=2.18,-2.21,-2.12,-2.61 and Z=-2.11,all P<0.05).Compared with the control group,the MVT(14.0±5.2d vs.18.4±6.3d),ICU LOS(19.3±4.9d vs.23.2±7.3d)and 28-day mortality(14.3%(3/21)vs.42.8%(10/21))in the PE group were significantly decreased(t=-2.48,-2.04 andχ^(2)=4.20,all P<0.05).There was no significant difference in the 90-d mortality between the two groups(28.6%(6/21)vs.52.4%(11/21),χ^(2)=2.47,P=0.208).Conclusion Therapeutic plasma exchange can significantly reduce the inflammatory response,improve the organ function and reduce the short-term mortality of ARDS patients.