中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (04): 245-249.doi: 10.3969/j.issn.1671-4091.2024.04.002

• 临床研究 • 上一篇    下一篇

体外二氧化碳清除治疗Ⅱ型呼吸衰竭的临床初探

万静怡    鲁 杨    户俊凯    马 旭    闫国胜    张宏涛   

  1. 450003 郑州，1郑州大学人民医院 河南省人民医院肾内科 河南省肾脏病免疫重点实验室河南省肾病临床医学研究中心
  • 收稿日期:2023-12-21 修回日期:2024-01-17 出版日期:2024-04-12 发布日期:2024-04-12
  • 通讯作者: 张宏涛 E-mail:zhtzzu@126.com
  • 基金资助:
    河南省重点研发专项项目(221111310800)

A preliminary clinical exploration of extracorporeal carbon dioxide removal therapy in the treatment of type Ⅱ respiratory failure

WAN Jing-yi, LU Yang, HU Jun-kai, MA Xu, YAN Guo-sheng, ZHANG Hong-tao   

  1. Department of Nephrology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Key Laboratory of Kidney Disease and Immunology, Henan Provincial Clinical Research Center for Kidney Disease, Zhengzhou 450003, China
  • Received:2023-12-21 Revised:2024-01-17 Online:2024-04-12 Published:2024-04-12
  • Contact: 450003 郑州，1郑州大学人民医院 河南省人民医院肾内科 河南省肾脏病免疫重点实验室河南省肾病临床医学研究中心 E-mail:zhtzzu@126.com

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摘要： 目的  探讨体外二氧化碳清除(extracorporeal carbon dioxide removal，ECCO2R)治疗接受连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)合并Ⅱ型呼吸衰竭患者的临床疗效。 方法 回顾性分析2020年12月—2022年7月就诊于重症监护室(intensive care unit，ICU)应用ECCO2R治疗合并Ⅱ型呼吸衰竭的CRRT患者(干预组)11例和同期未应用ECCO2R治疗的合并Ⅱ型呼吸衰竭的CRRT患者(对照组)11例，收集患者开始治疗前和治疗24小时后的血气分析结果，比较患者治疗前后动脉血二氧化碳分压(PaCO2)、pH值、动脉血氧分压(PaO2)、碱剩余(BE)、碳酸氢根(HCO3-)、乳酸(Lac)等指标的变化。 结果 与对照组相比，应用ECCO2R治疗前干预组PaCO2较高(Z=2.988,P=0.002)，治疗后差异无统计学意义(Z=-0.230,P=0.847)；应用ECCO2R治疗24小时后干预组pH值(t=-3.656,P=0.002)、BE(t=3.185,P=0.001)、HCO3-(t=2.791,P=0.004)、Lac(Z=-2.397,P=0.016)较对照组高。干预组应用ECCO2R治疗后，pH值较治疗前升高(t=-2.948,P=0.008)，PaCO2较治疗前下降(Z=-3.447,P＜0.001)。 结论 ECCO2R可纠正合并Ⅱ型呼吸衰竭CRRT患者的高碳酸血症，但能否改善预后尚需大样本临床研究。

关键词: 体外二氧化碳清除, 连续性肾脏替代治疗, Ⅱ型呼吸衰竭, 高碳酸血症

Abstract: Objective  To investigate the clinical efficacy of extracorporeal carbon dioxide removal (ECCO2R) therapy in patients with continuous renal replacement therapy combined with type Ⅱ respiratory failure. Methods  A retrospective analysis were performed, including 11 CRRT patients with type Ⅱ respiratory failure treated with ECCO2R in the intensive care unit (ICU) and 11 not treated CRRT patients with type Ⅱ respiratory failure as the control group from December 2020 to July 2022.  The results of blood gas analyses were collected from the patients before the treatment and 24 hours after the treatment. The changes in arterial blood carbon dioxide partial pressure (PaCO2), pH (acid-base), arterial blood oxygen partial pressure (PaO2), base remaining (BE), bicarbonate (HCO3-), and lactic acid (Lac) were compared between before and after the treatment.  Results Compared with the control group, PaCO2 was higher in the intervention group before the application of ECCO2R treatment (Z=2.988, P=0.002), but there was no significantly difference after the treatment (Z=-0.230, P=0.847). 24 hours after the application of ECCO2R treatment, pH (t=-3.656,  P=0.002), BE (t=3.185, P= 0.001), HCO3- (t=2.791, P=0.004), and Lac (Z=-2.397, P=0.016) were higher than in the control group. After the application of ECCO2R, pH was significantly higher (t=-2.948, P=0.008) and PaCO2 was significantly lower (Z=-3.447, P＜0.001) than before treatment in the intervention group. And there was no statistically significant change in PaO2 and hemodynamic parameters before and after treatment.  Conclusion  ECCO2R corrects hypercapnia in CRRT patients with type Ⅱ respiratory failure, but whether it has benefits to prognosis still requires large-scale clinical research.

Key words: Extracorporeal carbon dioxide removal, Continuous renal replacement therapy, Type II respiratory failure, Hypercapnia

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