体外二氧化碳清除治疗Ⅱ型呼吸衰竭的临床初探

A preliminary clinical exploration of extracorporeal carbon dioxide removal therapy in the treatment of type Ⅱ respiratory failure

目的探讨体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)治疗接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)合并Ⅱ型呼吸衰竭患者的临床疗效。方法回顾性分析2020年12月—2022年7月就诊于重症监护室(intensive care unit,ICU)应用ECCO_(2)R治疗合并Ⅱ型呼吸衰竭的CRRT患者(干预组)11例和同期未应用ECCO_(2)R治疗的合并Ⅱ型呼吸衰竭的CRRT患者(对照组)11例,收集患者开始治疗前和治疗24小时后的血气分析结果,比较患者治疗前后动脉血二氧化碳分压(PaCO_(2))、pH值、动脉血氧分压(PaO_(2))、碱剩余(BE)、碳酸氢根(HCO_(3)^(-))、乳酸(Lac)等指标的变化。结果与对照组相比,应用ECCO_(2)R治疗前干预组PaCO_(2)较高(Z=2.988,P=0.002),治疗后差异无统计学意义(Z=-0.230,P=0.847);应用ECCO_(2)R治疗24小时后干预组pH值(t=-3.656,P=0.002)、BE(t=3.185,P=0.001)、HCO_(3)^(-)(t=2.791,P=0.004)、Lac(Z=-2.397,P=0.016)较对照组高。干预组应用ECCO_(2)R治疗后,pH值较治疗前升高(t=-2.948,P=0.008),PaCO_(2)较治疗前下降(Z=-3.447,P<0.001)。结论EC-CO_(2)R可纠正合并Ⅱ型呼吸衰竭CRRT患者的高碳酸血症,但能否改善预后尚需大样本临床研究。

Objective To investigate the clinical efficacy of extracorporeal carbon dioxide removal(ECCO_(2)R)therapy in patients with continuous renal replacement therapy combined with type Ⅱ respiratory failure.Methods A retrospective analysis were performed,including 11 CRRT patients with type Ⅱ respiratory failure treated with ECCO_(2)R in the intensive care unit(ICU)and 11 not treated CRRT patients with type Ⅱ respiratory failure as the control group from December 2020 to July 2022.The results of blood gas analyses were collected from the patients before the treatment and 24 hours after the treatment.The changes in arterial blood carbon dioxide partial pressure(PaCO_(2)),pH(acid-base),arterial blood oxygen partial pressure(PaO_(2)),base remaining(BE),bicarbonate(HCO_(3)^(-)),and lactic acid(Lac)were compared between before and after the treatment.Results Compared with the control group,PaCO_(2) was higher in the intervention group before the application of ECCO_(2)R treatment(Z=2.988,P=0.002),but there was no significantly difference after the treatment(Z=-0.230,P=0.847).24 hours after the application of ECCO_(2)R treatment,pH(t=-3.656,P=0.002),BE(t=3.185,P=0.001),HCO_(3)^(-)(t=2.791,P=0.004),and Lac(Z=-2.397,P=0.016)were higher than in the control group.After the application of ECCO_(2)R,pH was significantly higher(t=-2.948,P=0.008)and PaCO_(2) was significantly lower(Z=-3.447,P<0.001)than before treatment in the intervention group.And there was no statistically significant change in PaO_(2) and hemodynamic parameters before and after treatment.Conclusion ECCO_(2)R corrects hypercapnia in CRRT patients with type Ⅱ respiratory failure,but whether it has benefits to prognosis still requires large-scale clinical research.