床旁CRRT联合俯卧位通气在重症ARDS患者中的疗效分析

Clinical analysis of bedside CRRT combined with prone position ventilation in severe ARDS patients

目的探讨床旁连续肾脏替代疗法(continuous renal replacement therapy,CRRT)联合俯卧位通气在重症急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中的疗效。方法回顾性分析2020年8月至2023年3月河南大学淮河医院收治的22例需行床旁CRRT联合俯卧位通气治疗的重症ARDS患者为研究对象,其中男8例、女14例,年龄(61.2±10.2)岁。对比患者治疗前后氧合指标、血流动力学、炎症指标。计量资料采用配对t检验。结果治疗后动脉血氧分压(PaO2)[(92.23±10.08)mmHg](1 mmHg=0.133 kPa)、脉搏血氧饱和度(SpO_(2))[(94.62±1.16)%]、氧合指数(PaO2/FiO2)[(280.02±25.64)mmHg]均高于治疗前[(56.25±7.14)mmHg、(85.07±2.69)%、(176.62±15.42)mmHg],动脉血二氧化碳分压(PaCO_(2))[(35.65±5.20)mmHg]低于治疗前[(47.72±8.69)mmHg],差异均有统计学意义(t=8.944、2.134、11.012、4.113,均P<0.05)。治疗后心率[(90.55±2.26)次/min]低于治疗前[(102.50±5.52)次/min],平均动脉压(MAP)[(80.05±5.35)mmHg]高于治疗前[(62.26±4.50)mmHg],差异均有统计学意义(t=2.375、5.125,均P<0.05);治疗前后中心静脉压(CVP)比较,差异无统计学意义(t=0.608,P>0.05)。治疗后血清C-反应蛋白(CRP)[(37.87±10.68)mg/L]、白细胞介素(IL)-1[(25.75±7.18)ng/L]、IL-6[(20.87±8.47)ng/L]、IL-10水平[(31.03±7.24)ng/L]均低于治疗前[(120.56±40.78)mg/L、(42.25±6.26)ng/L、(58.32±9.06)ng/L、(65.75±7.62)ng/L],差异均有统计学意义(t=10.177、3.241、6.262、6.014,均P<0.05)。患者28 d总体病死率为22.7%(5/22)。结论床旁CRRT联合俯卧位通气治疗重症ARDS患者显著改善氧合、血流动力学及炎症指标,为ARDS患者原发病的治疗赢得时间,促进患者康复。

Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)combined with prone position ventilation in patients with severe acute respiratory distress syndrome(ARDS).Methods Twenty two patients with severe ARDS who were admitted to Huaihe Hospital of Henan University from August 2020 to March 2023 and needed to be treated with bedside CRRT combined with prone position ventilation were selected,including 8 males and 14 females,aged(61.2±10.2)years.The patients'oxygenation index,hemodynamics,and inflammation indexes before and after treatment were compared.Paired t test was used for the measurement data.Results After treatment,the arterial partial oxygen pressure(PaO2)[(92.23±10.08)mmHg](1 mmHg=0.133 kPa),blood oxygen saturation(SpO2)[(94.62±1.16)%],and oxygenation index(PaO2/FiO2)[(280.02±25.64)mmHg]were all higher than those before treatment[(56.25±7.14)mmHg,(85.07±2.69)%,and(176.62±15.42)mmHg],while the arterial partial carbon dioxide pressure(PaCO2)[(35.65±5.20)mmHg]was lower than that before treatment[(47.72±8.69)mmHg],with statistically significant differences(t=8.944,2.134,11.012,and 4.113;all P<0.05).The heart rate[(90.55±2.26)beats/min]after treatment was lower than that before treatment[(102.50±5.52)beats/min],and the mean arterial pressure(MAP)[(80.05±5.35)mmHg]was higher than that before treatment[(62.26±4.50)mmHg],with statistically significant differences(t=2.375 and 5.125,both P<0.05).There was no statistically significant difference in the central venous pressure(CVP)before and after treatment(t=0.608,P>0.05).After treatment,the levels of C-reactive protein(CRP)[(37.87±10.68)mg/L],interleukin(IL)-1[(25.75±7.18)ng/L],IL-6[(20.87±8.47)ng/L],and IL-10[(31.03±7.24)ng/L]in serum were all lower than those before treatment[(120.56±40.78)mg/L,(42.25±6.26)ng/L,(58.32±9.06)ng/L,and(65.75±7.62)ng/L],with statistically significant differences(t=10.177,3.241,6.262,and 6.014;all P<0.05).The overall fatality rate at 28 days was 22.7%(5/22).Conclusion The combination of bedside CRRT and prone position ventilation significantly improves the oxygenation,hemodynamics,and inflammatory indicators in severe ARDS patients,buying time for the treatment of primary diseases in ARDS patients and promoting their recovery.