摘要
目的 探讨血液净化（CBP）在治疗重度颅脑损伤并发神经源性肺水肿（NPE）的临床应用价值及对血浆内皮素-1 （ET-1）含量的影响.方法 对60例重度颅脑损伤并发NPE患者进行前瞻性分析,随机（随机数字法）分为对照组和治疗组.对照组30例,采用降颅压、机械通气、镇静、抗感染等治疗;治疗组30例,在常规治疗基础上加CBP治疗.分别测定两组患者入科时及治疗72 h后血浆ET-1水平、氧合指数、静态肺顺应性变化,比较两组患者呼吸机治疗时间、多器官功能障碍综合征（MODS）发生率.计量资料组内比较采用配对t检验,各组相关资料构成比及发生率比较采用X2检验,以P ＜0.05为差异具有统计学意义.结果 与对照组比较,治疗组内皮素-1水平迅速下降[（48±10） ng/Lvs.（85±14） ng/L],静态肺顺应性[（60.9±2.3）mL/cmH2Ovs.（31.4 ±4.8）mL/cmH2O,1 cmH2O =0.098 kPa]、氧合指数[（317±11） mmHgvs.（192±14） mmHg,1 mmHg =0.133 kPa]明显提高,差异具有统计学意义（P＜0.05）.治疗组和对照组呼吸机治疗时间[（6.0±2.1）dvs.（11±3.2）d]及MODS发生率[20.0％ （6/30）vs.56.7％ （17/30）]比较差异具有统计学意义（P＜0.05）.结论 在常规综合治疗基础上加用CBP治疗,能有效清除患者血浆中内皮素-1,改善氧合,缩短机械通气时间,降低MODS发生率.
Objective To explore the influnce on the endothelin-1 （ET-1） and clinical application value of continuous blood purification （CBP） on the treatment of severe craniocerebral injury with the neurogenic pulmonary edema （NPE）.Methods All data about sixty patients with NPE were prospectively studied.These 60 patients were randomly （random number） divided into control group （n =30） and treatment group （n =30）.In control group,patients were rapidly given with lowering intracranial pressure,mechanical ventilation,calming,antibiotic therapy and so on.In the treatment group,patients received CBP integrated with routine treatment.On admission and 72 h posttreatment,ET-1,static lung compliance and oxygenation index were observed.Time of mechanical ventilation support,incidence rates of multipal organ dysfunction syndrome （MODS） were compared between two groups.The paired t-test was used for the amount data within the group.Chi-square was used for the constitute ratio and incidence ratio of the each relevant information.P 〈 0.05 was considered statistically significant.Results Compared to the control group,the level of ET-1 was decreased significantly in the treatment group [（48 ± 10） ng/L vs.（85 ± 14） ng/L] after 72 h post-treatment,while static lung compliance [（60.9 ± 2.3） mL/cmH2O vs.（31.4 ±4.8） mL/cmH2O] and oxygenation index [（317 ± 11） mmHg vs.（192 ± 14） mmHg] increased significantly （P 〈 0.05）.In treatment group and control group,the time of respirator intervention were [（6.0 ± 2.1） d vs.（11 ± 3.2） d],and the statistical significance was shown （P 〈 0.05）.Compared to the control group [56.7% （17/30）],incidence rate of MODS [20.0% （6/30）] was lower in treatment group （P 〈 0.05）.Conclusions CBP combined with routine treatment,which can remove ET-1 effectively,improve oxygenation,reduce the time of mechanical ventilation support and incidence rate of MODS.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2015年第4期427-430,共4页
Chinese Journal of Emergency Medicine
关键词
连续性血液净化
神经源性肺水肿
颅脑损伤
内皮素-1
连续性血液滤过
多器官功能障碍综合征
治疗
机械通气
Continuous blood purification
Neurogenic pulmonary edema
Craniocerebral injury
Endothelin-1
Continuous veno-vcnous hemofihration
Multiple organ dysfunction syndrome
Treatment
Mechanical ventilation
