高容量血液滤过对多器官功能障碍综合征患者呼吸力学和血流动力学的影响

目的 探讨高容量血液滤过对多器官功能障碍综合征(MODS)患者呼吸力学和血流动力学的影响.方法 选择各种病因的MODS患者41例,按照信封法随机分为高容量血液滤过(HVHF)组21例和连续性静脉-静脉血液滤过(CVVH)组20例.观察两组治疗前及治疗24 h气道峰压(Ppeak)、肺动态顺应性(Cdyn)、心排血量(CO)、外周循环阻力(SVR)、肺循环阻力(PVR)和血气分析.结果 HVHF组治疗24 h,Ppeak、Cdyn、CO、PVR、SVR、氧合指数分别为(31.32±2.23)cm H2O(1 cm H2O=0.098 kPa)、(26.18±3.54)ml/cm H2O、(6.18±0.91)L/min、(194.95±11.51)dyn·s·cm-5、(1071.55±66.50)dyn·s·cm-5、(220.41±21.41)mm Hg(1 mm Hg=0.133 kPa),与治疗前的(42.00±3.34)cm H2O、(17.91±4.31)ml/cm H2O、(8.68±1.17)L/min、(267.27±16.29)dyn·s·cm-5、(805.32±18.82)dyn·s·cm-5、(119.41±17.10)mm Hg比较,差异均有统计学意义(P＜0.01),且与CVVH组治疗24 h比较差异亦有统计学意义(P＜0.01).结论 HVHF可明显改善MODS患者的呼吸力学和血流动力学指标.

Abstract：

Objective To investigate the effect of continuous high volume hemofiltration (HVHF)on respiratory mechanics and hemodynamics in multiple organ dysfunction syndrome (MODS). MethodsForty-one adult patients with MODS who received mechanical ventilation were divided into HVHF group(21 cases) and continuous vein-vein hemofiltration (CVVH) group (20 cases) by envelople. The peak airway pressure (Ppeak), dynamic pulmonary compliance(Cdyn), cardiac output(CO ), systemic vascular resistance(SVR), pulmonary vascular resistance (PVR) and blood gas analysis before treatment and 24 hours after treatment were measured. Results Twenty-four hours after treatment, the levels of Ppeak, Cdyn, CO, PVR,SVR and oxygenation index were (31.32 ±2.23) cm H2O (1 cm H2O =0.098 kPa), (26.18 ±3.54)(220.41 ±21.41) mm Hg (1 mm Hg =0.133 kPa) respectively in HVHF group,significantly higher than those before treatment (42.00 ±3.34) cm H2O, (17.91 ±4.31) ml/cm H2O, (8.68 ±1.17) L/min,(267.27 ± 16.29) dyn·s·cm-5, (805.32 ± 18.82)dyn ·s·cm-5, ( 119.41 ± 17.10) mm Hg] (P ＜ 0.01 ),as well as higher than those in CVVH group after 24 hours' treatment (P ＜ 0.01 ). Conclusion HVHF shows significant beneficial effects on respiratory mechanics and hemodynamics of MODS.

The influence of continuous high volume hemofiltration on respiratory mechanics and hemodynamics in patients with multiple organ dysfunction syndrome

Objective To investigate the effect of continuous high volume hemofiltration (HVHF)on respiratory mechanics and hemodynamics in multiple organ dysfunction syndrome (MODS). MethodsForty-one adult patients with MODS who received mechanical ventilation were divided into HVHF group(21 cases) and continuous vein-vein hemofiltration (CVVH) group (20 cases) by envelople. The peak airway pressure (Ppeak), dynamic pulmonary compliance(Cdyn), cardiac output(CO ), systemic vascular resistance(SVR), pulmonary vascular resistance (PVR) and blood gas analysis before treatment and 24 hours after treatment were measured. Results Twenty-four hours after treatment, the levels of Ppeak, Cdyn, CO, PVR,SVR and oxygenation index were (31.32 ±2.23) cm H2O (1 cm H2O =0.098 kPa), (26.18 ±3.54)(220.41 ±21.41) mm Hg (1 mm Hg =0.133 kPa) respectively in HVHF group,significantly higher than those before treatment (42.00 ±3.34) cm H2O, (17.91 ±4.31) ml/cm H2O, (8.68 ±1.17) L/min,(267.27 ± 16.29) dyn·s·cm-5, (805.32 ± 18.82)dyn ·s·cm-5, ( 119.41 ± 17.10) mm Hg] (P ＜ 0.01 ),as well as higher than those in CVVH group after 24 hours' treatment (P ＜ 0.01 ). Conclusion HVHF shows significant beneficial effects on respiratory mechanics and hemodynamics of MODS.