摘要
目的 评估体外膜肺氧合(ECMO)与连续性肾脏替代治疗(CRRT)联合治疗急性呼吸窘迫综合征(ARDS)的效果.方法 选取2021年6月至2023年6月河南省人民医院收治的72例ARDS患者为研究对象.按照治疗方式的不同分成对照组与研究组,每组36例.对照组进行常规治疗,研究组在对照组治疗基础上加用ECMO与CRRT联合治疗.比较两组基本资料、氧合情况[动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、氧合指数、动脉血乳酸水平]、炎症指标[白细胞计数、降钙素原(PCT)、C-反应蛋白(CRP)]、急性生理和慢性健康评分Ⅱ(APACHE Ⅱ评分)以及治疗相关指标.结果 治疗前,两组PaO2、PaCO2、氧合指数及乳酸水平比较差异未见统计学意义(P＞0.05);治疗3 d后,两组PaO2、氧合指数明显升高,PaCO2、动脉血乳酸水平显著降低,且研究组上述指标变化更明显,差异均有统计学意义(P＜0.05).治疗前,两组白细胞计数、PCT、CRP水平比较差异未见统计学意义(P＞0.05);治疗3 d后,两组白细胞计数、PCT、CRP水平均明显降低,且研究组低于对照组,差异均有统计学意义(P＜0.05).治疗前,两组APACHE Ⅱ评分比较差异未见统计学意义(P＞0.05);治疗3 d后,两组APACHE Ⅱ评分均显著下降,且研究组下降更明显,差异均有统计学意义(P＜0.05).研究组机械通气时间、ICU住院时间和总住院时间明显短于对照组,差异有统计学意义(P＜0.05).结论 ECMO联合CRRT治疗ARDS患者效果显著,能够改善氧合功能,减轻炎症反应,缩短机械通气时间,降低病死率,是一种安全有效的治疗策略.
Abstract
Objective To evaluate the clinical effect of extracorporeal membrane oxygenation(ECMO)combined with continuous renal replacement therapy(CRRT)on patients with acute respiratory distress syndrome(ARDS).Methods Seventy-two ARDS patients admitted to Henan Provincial People's Hospital from June 2021 to June 2023 were selected as the research subjects.They were divided into a control group and a study group according to different treatment methods,with 36 cases in each group.The control group received routine treatment,while the study group received a combination of ECMO and CRRT in addition to the treatment in the control group.The basic data,oxygenation status(PaO2,PaCO2,oxygenation index,arterial lactate level),inflammatory indicators[leukocytes,procalcitonin(PCT),C-reactive protein(CRP)],acute physiological and chronic health score Ⅱ(APACHE Ⅱ score)and treatment-related indicators were compared between the two groups.Results Before treatment,there was no significant difference in PaO2,PaCO2,oxygenation index or lactate levels between the two groups(P＞0.05).After 3 days of treatment,PaO2 and oxygenation index significantly increased in both groups,while PaCO2 and arterial blood lactate levels significantly decreased;moreover,the above indicators in the study group showed more significant changes,and the differences were significant(P＜0.05).Before treatment,Before treatment,there was no significant difference in the levels of white blood cells,PCT or CRP between the two groups(P＞0.05).After 3 days of treatment,the levels of white blood cells,PCT,and CRP in both groups were significantly reduced,and those of the study group were lower than those of the control group,with significant differences(P＜0.05).Before treatment,there was no significant difference in APACHE Ⅱ scores between the two groups(P＞0.05).After 3 days of treatment,both groups showed a significant decrease in APACHE Ⅱ scores,and the study group showed a more significant decrease,with significant differences(P＜0.05).The mechanical ventilation time,ICU hospitalization time,and total hospitalization time of the study group were significantly shorter than those of the control group,and the differences were significant(P＜0.05).Conclusions ECMO combined with CRRT is effective on ARDS patients,which can improve oxygenation function,reduce inflammatory response,shorten the duration of mechanical ventilation,and reduce mortality,which is a safe and effective treatment strategy.
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