中国血液净化

›› 2006, Vol. 5 ›› Issue (2): 69-71.

• 论著 • 上一篇    下一篇

持续高容量血液滤过对急性呼吸窘迫综合征血流动力学和氧代谢的影响

刘长文 陆 骏 郑永科 朱克毅 胡 炜   

  1. 310006 杭州,浙江省杭州市第一人民医院危重病医学科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-02-12 发布日期:2006-02-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-02-12 Published:2006-02-12

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摘要： 目的 探讨持续高容量血液滤过(CHVHF)对急性呼吸窘迫综合征呼吸、血流动力学和氧代谢的影响。方法 选择杭州市第一人民医院由各种病因导致的ARDS 12例患者，全部病例均在呼吸机支持下给予72h连续高容量血液滤过（置换液流速6L/h），通过Swan-Ganz导管获得心输出量（CO）、外周循环阻力（SVR）、肺循环阻力（PVR）、平均肺动脉压（mPAP）、肺动脉楔压（PAWP）、动脉血氧含量（CaO2）、混合静脉血氧含量（CvO2）、氧消耗（VO 2）和氧摄取率（O2ER）。利用美国BioZ LISA方法检测CHVHF前、后肿瘤坏死因子(TNFα)、白细胞介素(IL-6)、IL-8和 IL-10的变化。结果 CHVHF72h后，TNFα、IL-1、IL-6和IL-8较CHVHF前明显下降(P＜0.05)，CHVHF72h后PAP和PVR明显下降（P＜0.05)。在CHVHF后72h DO2、O2ER和VO2逐渐稳定，并伴随动脉氧分压（PaO 2）、氧合指数（PaO2/FiO2）和气道峰压（Ppeak）的改善（P＜0.05)。结论 持续高容量血液滤过（CHVHF）可通过清除部分细胞因子，明显改善ARDS患者的氧代谢。

关键词: 持续高容量血液滤过, Swan-Ganz导管, 氧代谢

Abstract:

Objective To investigate the effect of continuous high volume hemofiltration on blood kinetics and oxygen metabolism in acute respiratory distress syndrome (ARDS). Methods Twelve adult patients with ARDS who received mechanical ventilation were treated with CHVHF (6L/h) for 72 hours. The cardiac output(CO),systemic vascular resistance(SVR),pulmonary vascular resistance(PVR),mean pulmonary arterial pressure(mPAP)、pulmonary artery wedge pressure(PAWP)、arterial oxygen content（CaO2）、content of mixed venous blood（CvO2）、oxygen consumption（VO2）and oxygen extraction rate （O2ER）were measured by Swan-Ganz catheter, the thoracic fluid content were measured with BioZ?Cardio Dynamics. Concentrations of TNFα, IL-6, IL-8 and IL-10 were measured pre-CHVHF and after CHVHF by ELISA. Results There were significant descent of TNFα, IL-1, IL-6 and IL-8 levels after CHVHF at 72 hours(P＜0.05), and PAP and PVR after 24 hours(P ＜0.05). The stabilization of DO2、VO2 and O2ER was at 72 hours with amelioration of PaO2/FiO2 and peak airway pressure (Ppeak) (P＜0.05).Conclusion CHVHF shows significant beneficial effects on pulmonary function of ARDS as the result of removal of cytokines and ameliorationtion of oxygen metabolism.

Key words: Swan-Ganz catheter, Oxygen metabolism

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