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不同血液滤过对重症急性胰腺炎合并急性呼吸窘迫综合征的疗效研究 预览

Evaluation of different hemofiltration for the treatment of severe acute pancreatitis combined with ARDS
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摘要 目的分析两种不同的血液滤过方式对于重症急性胰腺炎(severe acute pancreatitis,SAP)合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的治疗效果差异。方法回顾性分析2015-01至2018-06,179例住院的SAP合并ARDS患者资料,根据血液滤过的置换液流速将入选病例分为高容量滤过组94例和低容量滤过组85例。分析比较两组患者的临床特征、疗效指标及预后。结果两组患者一般资料比较,差异无统计学意义(P>0.05)。血流动力学改变和急性生理学及慢性健康状况系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分,治疗后各时间点同组内比较,高容量滤过组和低容量滤过组心率(heart ratio,HR)和APACHEⅡ与治疗前比较,评分均下降而平均动脉压(mean arterial pressure,MAP)升高,差异有统计学意义(P<0.05);治疗后24 h组间比较,高容量滤过组HR、MAP和APACHEⅡ评分改善均优于低容量滤过组,差异有统计学意义(P<0.05)。同组内肺气体交换指标比较,治疗后各时间点的pH、动脉血氧分压(arterial partial pressure of oxygen,PaO2)和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2)均较治疗前升高,差异具有统计学意义(P<0.05)。组内比较,血液滤过治疗后两组患者的白细胞(white blood cell,WBC)、C-反应蛋白(C-reactive protein,CRP)和降钙素原(procalcitonin,PCT)均降低,差异具有统计学意义(P<0.05)。高容量滤过组的机械通气时间、通气例数和住院时间、并发症例数均低于低容量组,但存活率高于低容量组,但差异均无统计学意义(P>0.05)。结论不同血液滤过均可有效促进心肺功能恢复,降低APACHEⅡ评分,且置换液流速的高低并不影响短期、远期治疗效果。 Objective The objective of this study was to compare the therapeutic effect of two hemofiltration methods for patients with severe acute pancreatitis (SAP) combined with acute respiratory distress syndrome (ARDS). Methods The data of patients with SAP combined with ARDS from January 2015 to June 2018 were retrospectively analyzed. The patients were divided into high-volume hemofiltration group (n=94) and low-volume hemofiltration group (n=85) according to the flow rate of replacement fluid. The clinical characteristics, curative effects, and outcomes were analyzed. Results There was no significant differences in the clinical characteristics between two groups (P>0.05). The APACHE Ⅱ scores and heart ratio (HR) after the treatment were significantly decreased, the mean arterial pressure (MAP) was significantly increased at each time point in the high-volume hemofiltration group, and the differences were statistically significant (P<0.05). The APACHE Ⅱ scores, HR and MAP in the high-volume group were significantly better than that in the low-volume group at 24 h after hemofiltration, and the difference was statistically significant (P<0.05). The pH, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were significantly increased at each time point after treatment in both groups as compared with those before the treatment (P<0.05). The white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were significantly decreased after treatment in both groups, and the differences were statistically significant (P<0.05). The mechanical ventilation time, the number of ventilation cases, the length of hospital stay, and the number of complications in the high-volume group were lower than those in the low-volume group, while the survival rate was higher than that in the low-volume group. And the differences were not statistically significant (P>0.05). Conclusions Both hemofiltration methods can effectively promote the recovery of cardiopulmonary function and reduc
作者 刘秋艳 张国秀 LIU Qiuyan;ZHANG Guoxiu(Department of Critical Care Medicine, The First Hospital of Traditional Chinese Medicine, Luoyang471003, China;College of Clinical Medicine and Department of Emergency Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China)
出处 《中华灾害救援医学》 2019年第4期212-216,共5页 Chinese Journal of Disaster Medicine
关键词 重症急性胰腺炎 急性呼吸窘迫综合征 血液滤过 severe acute pancreatitis acute respiratory distress syndrome hemofiltration
作者简介 通信作者:张国秀,E-mail:1530556747@qq.com.
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