论文部分内容阅读
目的:观察急性呼吸窘迫综合征患者采用连续肾脏替代疗法、乌司他丁联合治疗的疗效。方法:选择2017年1月至2018年12月临海市第一人民医院重症监护室收治的急性呼吸窘迫综合征患者92例作为研究对象。按照来诊时间排序，序列号为单双号分别做对照组和观察组各46例。所有患者给予抗炎、机械通气等常规治疗，对照组患者给予连续肾脏替代疗法治疗。观察组在对照组治疗方案基础上给予注射用乌司他丁治疗。比较两组患者治疗前后血清炎性因子水平、氧合状态、病死率、机械通气时间、重症加强护理病房(ICU)住院时间，以及治疗期间并发症发生情况。结果:两组患者治疗后白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)与治疗前相比均有改善(均n P<0.05)，但观察组水平均低于对照组，且差异均有统计学意义(n t＝4.810，n P<0.001；n t＝3.081，n P＝0.003；n t＝7.046，n P<0.001；n t＝5.809，n P<0.001)；两组患者治疗后动脉血气中的氧分压(PaOn 2)、二氧化碳分压(PaCOn 2)、氧合指数(OI)(PaOn 2/FiOn 2)、pH与治疗前相比均有改善，但观察组PaOn 2、PaCOn 2、OI均高于对照组(n t＝4.999，n P<0.001；n t＝2.817，n P＝0.007；n t＝2.896，n P＝0.005)，两组pH值差异无统计学意义(n t＝1.435，n P＝0.157)；观察组患者病死率(4.35%)、并发症发生率(34.78%)均明显低于对照组(17.39%、56.52%)(χn 2＝4.039，n P＝0.044；χn 2＝4.381，n P＝0.036)；观察组患者机械通气时间和ICU住院时间均明显短于对照组，且差异均有统计学意义(n t＝3.883，n P<0.001；n t＝4.328，n P＝0.007)。n 结论:连续肾脏替代疗法联合乌司他丁能够降低急性呼吸窘迫综合征患者病死率和并发症发生率，改善患者氧合状态，降低炎性因子水平，具有重要的临床应用价值。“,”Objective:To observe the effect of continuous renal replacement therapy and ulinastatin combined therapy on acute respiratory distress syndrome(ARDS).Methods:From January 2017 to December 2018, 92 patients with ARDS treated in intensive care unit(ICU) of the First People's Hospital of Linhai were selected in the study.According to the order of visiting time, the patients were divided into the control group and the observation group, with 46 cases in each group.All patients were given routine anti-inflammation, mechanical ventilation and other conventional treatment, the control group was given continuous renal replacement therapy.The observation group was treated with ulinastatin injection on the basis of the control group.The levels of serum inflammatory factors, oxygenation status, mortality, mechanical ventilation time, hospitalization time in ICU and complications during treatment were compared between the two groups before and after treatment.Results:After treatment, the levels of IL-6, TNF-α, CRP and PCT in the two groups were improved compared with before treatment(alln P<0.05), and the levels in the observation group were lower than those in the control group (n t=4.810, n P<0.001;n t=3.081, n P=0.003; n t=7.046, n P<0.001;n t=5.809, n P<0.001). After treatment, the levels of PaOn 2, PaCOn 2, OI and pH in the two groups were all lower than those before treatment(all n P<0.05). However, the levels of PaOn 2, PaCOn 2 and OI in the observation group were higher than those in the control group(n t=4.999, n P<0.001;n t=2.817, n P=0.007; n t=2.896, n P=0.005). There was no statistically significant difference in pH value between the two groups(n t=1.435, n P=0.157). The mortality rate in the observation group was 4.35%, which was significantly lower than that in the control group(17.39%), and the incidence of complications in the observation group was 34.78%, which was significantly lower than that in the control group(56.52%), and there were statistically significant differences between the two groups(χn 2=4.039, n P=0.044; χ n 2=4.381, n P=0.036). The duration of mechanical ventilation and ICU hospitalization in the observation group were significantly lower than those in the control group (n t=3.883, n P<0.001;n t=4.328, n P=0.007).n Conclusion:Continuous renal replacement therapy combined with ulinastatin can reduce the mortality and incidence of complication in patients with ARDS, improve oxygenation status and reduce the levels of inflammatory factors, which has important clinical application value.