持续高容量血液滤过对急性呼吸窘迫综合征患者呼吸力学和血流动力学的影响

目的 探讨持续高容量血液滤过(HVHF)对急性呼吸窘迫综合征(ARDS)患者呼吸力学和血流动力学的影响. 方法 选择由各种病因导致的ARDS患者22例,全部病例均在呼吸机支持下给予48 h的HVHF,在HVHF治疗前及治疗后12、24和48 h监测并记录气道峰压、动态肺顺应性、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、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治疗后48 h,气道峰压、动态肺顺应性、MPAP、PAWP、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、(32.05±1.99)mm Hg(1 mnl Hg=0.133 kPa)、(12.14±1.78)mm Hg,(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,均得到明显改善(P＜0.01). 结论 HVHF可明显改善ARDS患者的呼吸力学和血流动力学.

The influence of continuous high volume hemofiltration on respiratory mechanics and hemody namics in patients with acute respiratory distress syndrome

Objective To investigate the effect of continuous high volume hemofiltration(HVHF)on respiratory mechanics and hemodynamics in patients with acute respiratory distress syndrome(ABDS).Methods Twenty-two patients with ARDS who received mechanical ventilation were treated with HVHF(6 L/h) for 48 hours.The cardiac output(CO),systemic vascular resistance(SVR),pulmonary vascular resistance (PVR),mean pulmonary arterial pressure(MPAP),pulmonary artery wedge pressure(PAWP),PaO2/FiO2 and peak airway pressure(Ppeak)was measured.Results The Ppeak,Cdyn,MPAP,PAWP,CO,PVR,SVR and PaO2/FiO2 after HVHF at 48 hours was(31.32±2.23)cm H2O,(26.18±3.54)ml/cm H2O,shows significantly benelicial effects on respiratory mechanics and hemodynamics of ARDS.