乌司他丁联合持续血液净化对ARDS患者呼吸功能及血流动力学的影响
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摘要
目的探讨乌司他丁联合持续血液净化对ARDS患者呼吸功能及血流动力学的影响。方法选择我院2016年2月～2017年2月收治的88例ARDS患者,随机分为治疗组与对照组,各44例。对照组采用持续血液净化+静脉滤过治疗,治疗组在对照组基础上+乌司他丁治疗,观察两组患者治疗前、治疗1、3、7 d后呼吸功能及治疗前后血流动力学指标,比较两组机械通气时间、APACHE-Ⅱ评分、ICU病房时间及死亡率。结果两组治疗后SaO_2、PaO_2及PaO_2/FiO_2指标均上升(P<0.05)。治疗1、3 d后,治疗组SaO_2、PaO_2及PaO_2/FiO_2指标高于对照组(P<0.05)。两组治疗后CL水平上升、Raw及PIP水平下降,治疗3、7 d后与治疗前比较,差异有统计学意义(P<0.05)。两组治疗前及治疗1、7 d后CL、Raw及PIP水平组间比较无明显差异。治疗3 d后,两组CL、Raw及PIP水平比较,差异有统计学意义(P<0.05)。两组治疗后HR、MAP、PCWP及CI等血流动力学指标均明显改善(P<0.05),但组间比较,差异无统计学意义(P>0.05)。治疗组机械通气时间、APACHE-Ⅱ评分、ICU病房时间及死亡率均低于对照组(P<0.05)。结论乌司他丁联合CBP治疗能够有效改善ARDS患者动脉血气指标、呼吸功能以及血流动力学,减少患者机械通气时间、住ICU病房时间,降低患者的死亡率,疗效满意,值得推广应用。
Objective To investigate the effects of ulinastatin combined with continuous blood purification(CBP) on respiratory function and hemodynamics in patients with ARDS. Methods A total of 88 patients with ARDS admitted to our hospital from February 2016 to February 2017 were randomly divided into treatment group and control group, 44 cases in each group. The control group was treated with CBP and venous filtration, while the treatment group was treated with ulinastatin on the basis of the control group. Respiratory function and hemodynamic parameters were observed before treatment, 1, 3 and 7 days after treatment, and mechanical ventilation time, APACHE-Ⅱ score, ICU ward time and mortality were compared between the two groups. Result After treatment, the indexes of SaO_2, PaO_2 and PaO_2/FiO_2 increased in both groups(P<0.05). After 1 day and 3 days of treatment, the indexes of SaO_2, PaO_2 and PaO_2/FiO_2 in the treatment group were higher than those in the control group(P<0.05). After treatment, CL level increased and Raw and PIP level decreased in both groups. After 3 and 7 days of treatment, compared with those before treatment, the differences were statistically significant(P<0.05). After treatment, CL level increased and Raw and PIP level decreased in both groups. After 3 and 7 days of treatment, they were compared with those before treatment, the differences were statistically significant(P<0.05). There was no significant difference in the levels of CL, Raw and PIP between the two groups before treatment and 1 day and 7 days after treatment. After 3 days of treatment, the levels of CL, Raw and PIP were significantly different between the two groups(P<0.05). After treatment, HR, MAP, PCWP, CI and other hemodynamic indicators were significantly improved in both groups(P<0.05), but there was no significant difference between the two groups(P>0.05). The duration of mechanical ventilation, APACHE-Ⅱ score, ICU ward time and mortality in the treatment group were lower than those in the control group(P<0.05). Conclusion Ulinastatin combined with CBP can effectively improve the arterial blood gas index, respiratory function and hemodynamics of ARDS patients, reduce the duration of mechanical ventilation, ICU ward time and reduce the mortality rate of patients. The curative effect is satisfactory, and it is worth popularizing and applying.
Objective To investigate the effects of ulinastatin combined with continuous blood purification(CBP) on respiratory function and hemodynamics in patients with ARDS. Methods A total of 88 patients with ARDS admitted to our hospital from February 2016 to February 2017 were randomly divided into treatment group and control group, 44 cases in each group. The control group was treated with CBP and venous filtration, while the treatment group was treated with ulinastatin on the basis of the control group. Respiratory function and hemodynamic parameters were observed before treatment, 1, 3 and 7 days after treatment, and mechanical ventilation time, APACHE-Ⅱ score, ICU ward time and mortality were compared between the two groups. Result After treatment, the indexes of SaO_2, PaO_2 and PaO_2/FiO_2 increased in both groups(P<0.05). After 1 day and 3 days of treatment, the indexes of SaO_2, PaO_2 and PaO_2/FiO_2 in the treatment group were higher than those in the control group(P<0.05). After treatment, CL level increased and Raw and PIP level decreased in both groups. After 3 and 7 days of treatment, compared with those before treatment, the differences were statistically significant(P<0.05). After treatment, CL level increased and Raw and PIP level decreased in both groups. After 3 and 7 days of treatment, they were compared with those before treatment, the differences were statistically significant(P<0.05). There was no significant difference in the levels of CL, Raw and PIP between the two groups before treatment and 1 day and 7 days after treatment. After 3 days of treatment, the levels of CL, Raw and PIP were significantly different between the two groups(P<0.05). After treatment, HR, MAP, PCWP, CI and other hemodynamic indicators were significantly improved in both groups(P<0.05), but there was no significant difference between the two groups(P>0.05). The duration of mechanical ventilation, APACHE-Ⅱ score, ICU ward time and mortality in the treatment group were lower than those in the control group(P<0.05). Conclusion Ulinastatin combined with CBP can effectively improve the arterial blood gas index, respiratory function and hemodynamics of ARDS patients, reduce the duration of mechanical ventilation, ICU ward time and reduce the mortality rate of patients. The curative effect is satisfactory, and it is worth popularizing and applying.
引文
[1]黄琳娜,夏金根,李正东,等.急性呼吸窘迫综合征呼吸支持策略与方式选择[J].中华结核和呼吸杂志,2016,39(1):51-54.
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[11]陈建.连续性血液净化对急性呼吸窘迫综合征的治疗机制及效果[J].实用临床医药杂志,2015,19(15):94-96.
[12]Li ZB,Wen DL,Liu WJ,et al.Effects of continuous blood purification on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome[J].Journal of Southern Medical University,2015,35(7):1047-1049.
[13]赵承满,孟立娜,陈锦龙,等.乌司他丁对溃疡性结肠炎大鼠结肠炎症及TLR4/NF-κB信号通路的影响[J].中国现代应用药学,2017,34(3):347-351.
[14]黄庆生,张丽霞,李燕,等.乌司他丁联合无创通气治疗急性呼吸窘迫综合征的临床研究[J].中国临床药理学杂志,2016,32(14):1268-1271.
[15]蒋永泼,林荣海,徐颖鹤,等.连续血液净化治疗内毒素诱导的急性呼吸窘迫综合征的研究[J].浙江医学,2016,38(20):1637-1642.
[16]季明霞,斯小水,何建新,等.乌司他丁联合持续血液净化治疗对急性呼吸窘迫综合征患者肺血管内皮通透性的影响研究[J].中国全科医学,2015,18(6):688-691.
[2]雍伟哲.急性呼吸窘迫综合征患者机械通气指南(试行)[J].中华医学杂志,2016,96(4):5.
[3]张志强,马海英,冯宪军,等.重症肺炎合并重度急性呼吸窘迫综合征患者临床特点与预后影响因素分析[J].中华医院感染学杂志,2016,26(6):1297-1299.
[4]崔广清,孙卫和,冒秀宏,等.血管外肺水指数变化对早期急性呼吸窘迫综合征患者预后的评价[J].实用医学杂志,2016,32(1):76-78.
[5]郭龙,张春媚,高勇,等.ARDS发病机制的相关信号通路研究进展[J].中国实验诊断学,2017,21(9):1647-1650.
[6]孙佳,朱彪.ACE2/Ang1-7/Mas在ALI/ARDS中作用机制研究[J].国际呼吸杂志,2016,36(8):632-635.
[7]Qi Di,Tang Xumao,He Jing,et al.Omentin protects against LPS-induced ARDS through suppressing pulmonary inflammation and promoting endothelial barrier via an Akt/eNOS-dependent mechanism[J].Cell Death&Disease,2016,7(9):236-240.
[8]李智博,温德良,刘卫江,等.连续性血液净化对肺外源ARDS患者肺血管外肺水及呼吸功能的影响[J].南方医科大学学报,2015,35(7):1047-1049.
[9]宋邵华,田惠玉,杨秀芬,等.气道压力释放通气应用于急性肺损伤/急性呼吸窘迫综合征患者的研究[J].中华危重病急救医学,2016,21(1):15-21.
[10]徐晓鸿,陈家斌,夏银稳.连续性血液净化对急性呼吸窘迫综合症的疗效研究[J].海南医学院学报,2016,52(1):41-44.
[11]陈建.连续性血液净化对急性呼吸窘迫综合征的治疗机制及效果[J].实用临床医药杂志,2015,19(15):94-96.
[12]Li ZB,Wen DL,Liu WJ,et al.Effects of continuous blood purification on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome[J].Journal of Southern Medical University,2015,35(7):1047-1049.
[13]赵承满,孟立娜,陈锦龙,等.乌司他丁对溃疡性结肠炎大鼠结肠炎症及TLR4/NF-κB信号通路的影响[J].中国现代应用药学,2017,34(3):347-351.
[14]黄庆生,张丽霞,李燕,等.乌司他丁联合无创通气治疗急性呼吸窘迫综合征的临床研究[J].中国临床药理学杂志,2016,32(14):1268-1271.
[15]蒋永泼,林荣海,徐颖鹤,等.连续血液净化治疗内毒素诱导的急性呼吸窘迫综合征的研究[J].浙江医学,2016,38(20):1637-1642.
[16]季明霞,斯小水,何建新,等.乌司他丁联合持续血液净化治疗对急性呼吸窘迫综合征患者肺血管内皮通透性的影响研究[J].中国全科医学,2015,18(6):688-691.