不同时机连续性肾脏替代治疗对急性呼吸窘迫综合征的影响

doi:10.3969/j.issn.1002-1949.2018.01.015

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摘要目的：观察不同时机连续性肾脏替代治疗（CRRT）对急性呼吸窘迫综合征（ARDS）的影响，探讨ARDS患者应用CRRT的时机。方法： 48例中重度ARDS患者随机分为早期CRTT组（入ICU 24 h内行CRRT）和晚期CRRT组（入ICU 24 h后行CRRT），每组24例，分别在治疗前和治疗后第2天、第7天监测氧合指数（PaO2/FiO2）、呼气末正压（PEEP）、平台压（Pplat）以及中心静脉压（CVP）、平均动脉压(MAP)、血乳酸(Lac)和去甲肾上腺素使用剂量,并进行比较；对两组患者液体总负荷、机械通气时间、住ICU时间及28 d病死率也进行比较。结果：早期CRRT组患者PaO2/FiO2、PEEP、Pplat、CVP、MAP在治疗后第2天即出现明显改善，Lac在治疗后第2天出现明显下降；而晚期CRRT组患者上述指标的改善及Lac的下降均晚于早期CRRT组，且在治疗后第2天、第7天两组上述指标比较差异有统计学意义。两组机械通气时间分别为（8.5±3.1）d和（14.4±4.1）d（P＜0.05），住ICU时间分别为（12±2）d 和（19±5）d（P＜0.05），28 d病死率分别为20.83%和 37.5%（P＜0.05）。结论： CRRT可以改善ARDS患者临床预后，24 h内行CRRT治疗能尽早地改善氧合，稳定血流动力学，缩短机械通气时间和住ICU时间，降低病死率。

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	孟丽君
	刘微丽

收稿日期: 2017-07-31

作者简介: 孟丽君（1983-），女，主治医师，E-mail:menglj_2006@sina.com。

引用本文:

孟丽君，刘微丽. 不同时机连续性肾脏替代治疗对急性呼吸窘迫综合征的影响[J]. 中国急救医学, 2018, 38(1): 67-71.
Meng Li-jun, Liu Wei-li. Initiation time of continuous renal replacement therapy on patients with acute respiratory distress syndrome. Chinese Journal of Critical Care Medicine, 2018, 38(1): 67-71.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.01.015 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I1/67

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