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目的观察高置换率和低置换率连续性肾脏替代治疗(CRRT)对重症胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)时呼吸循环及外周血TNF-α水平的影响.方法回顾性分析2001年以来在我院接受治疗的SAP合并ARDS、并接受呼吸机和CRRT治疗的患者,共22例.按每位患者接受CRRT置管率的不同分为2组A组(10例,CRRT置换率为2L/h),B组(12例,CRRT置换率为4L/h).记录给予CRRT治疗前、治疗后6,12,24h的实测呼吸频率、心率和无创动脉血压;于上述相应时点抽取动脉血做动脉血气分析,并留取血样,使用ELISA法测定血清TNF-α水平.结果CRRT后两组患者的氧合指数和呼吸均有明显的改善(与治疗前比较,P<0.01),血压、心率也趋于稳定(与治疗前比较,P<0.05或<0.01),其中B组的变化更为显著(与A组比较,P<0.05或<0.01);CRRT后两组患者的外周血TNF-α水平均有明显降低(与治疗前比较,P<0.01),其中B组患者血TNF-α水平的改变更为显著(与A组比较,P<0.01).结论高置换率CRRT能较低置换率CRRT更有效地清除SAP合并ARDS患者体内的炎症因子,因而更有利于其呼吸循环功能的改善.
Objective To investigate the effects of high replacement rate and low replacement rate renal replacement therapy (CRRT) on respiratory circulation and peripheral blood TNF-α levels in severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS) .Methods Retrospective analysis A total of 22 patients with SAP-treated ARDS and ventilator-treated and CRRT-treated patients treated in our hospital since 2001 were divided into two groups, Group A (10 CRRT permutations Rate was 2 L / h), and group B (12 CRRT replacement rate was 4 L / h) .The measured respiratory rate, heart rate and noninvasive arterial blood pressure before and 6, 12 and 24 h after CRRT treatment were recorded, The arterial blood gas was extracted from the artery and blood samples were taken for determination of serum TNF-α levels by ELISA.Results The oxygenation index and respiration of the two groups after CRRT were significantly improved (compared with those before treatment, P <0.01 ), Blood pressure and heart rate also tended to be stable (compared with those before treatment, P <0.05 or <0.01), of which the changes in group B were more significant (P <0.05 or <0.01 compared with group A) The levels of TNF-α in peripheral blood were significantly decreased (compared with before treatment, P <0.01), and the changes of blood TNF-α in group B were more obvious (P <0.01) .Conclusion CRRT with high replacement rate can lower the replacement rate of CRRT more effectively in patients with SAP and ARDS, which is more conducive to the improvement of respiratory function.