论文部分内容阅读
目的观察连续性血液净化对重症肺炎合并多器官功能衰竭患者的治疗效果。方法选取2013年1月至2015年1月兵器工业卫生研究所收治的重症肺炎合并多器官功能衰竭患者68例。按照随机数字表法分为观察组和对照组,各34例。对照组采用常规治疗,包括吸氧、利尿、强心、镇静等治疗,观察组在此基础上加以连续性血液净化,治疗的时间持续在5~20 d。比较治疗前和治疗5 d后的肾功能指标[血肌酐(SCr)、血尿素氮(BUN)]、血气指标[pH值、动脉血氧分压(PaO_2)、动脉血氧饱和度(SaO_2)],生命体征[呼吸频率、心率、血压]。观察两组患者的临床症状消失时间(咳嗽改善时间、心率减慢时间及水肿消失时间)和临床疗效。结果治疗后,观察组SCr、BUN显著低于对照组[(178±15)μmol/L比(278±20)μmol/L,(14.9±2.4)mmol/L比(22.6±3.8)mmol/L],p H值、PaO_2、SaO_2显著高于对照组[(7.9±0.9)比(7.3±0.9)、(89±12)mm Hg(1 mm Hg=0.133 k Pa)比(71±10)mm Hg、0.95±0.03比0.82±0.02],差异有统计学意义(P<0.05)。治疗后,观察组患者呼吸频率、心率低于对照组[(18±3)次/min比(25±4)次/min、(89±8)次/min比(96±10)次/min],平均动脉压和24 h尿量高于对照组[(83.8±14.2)mm Hg比(73.4±12.3)mm Hg、(1346±64)m L比(835±56)m L],差异有统计学意义(P<0.05)。观察组患者总的疗效率高于对照组[88.24%(30/34)比67.65%(23/34)](P<0.05)。观察组患者的咳嗽改善时间、心率减慢时间及水肿消失时间短于对照组[(3.0±0.6)d比(5.6±1.3)d、(7.3±1.2)d比(10.2±1.7)d、(4.5±0.4)d比(6.9±1.2)d],差异有统计学意义(P<0.01)。结论重症肺炎合并多器官功能衰竭患者采用连续性血液净化治疗,能显著改善患者的肾功能、动脉血气指标、生命体征等情况,可缩短患者的临床症状改善时间,临床疗效良好。
Objective To observe the therapeutic effect of continuous blood purification on patients with severe pneumonia complicated with multiple organ failure. Methods Sixty-eight patients with severe pneumonia complicated with multiple organ failure who were admitted to Weaponry Institute of Health from January 2013 to January 2015 were selected. According to random number table divided into observation group and control group, each 34 cases. The control group received routine treatment, including oxygen, diuretic, cardiac, sedation and other treatment, the observation group on this basis to be continuous blood purification, the treatment time lasted 5 to 20 days. The levels of serum creatinine (SCr), blood urea nitrogen (BUN) and blood gas index (pH, PaO_2, SaO_2) were compared before treatment and 5 days after treatment. ], Vital signs [respiratory rate, heart rate, blood pressure]. The disappearance of clinical symptoms (time to improve cough, time to heart rate and disappearance of edema) and clinical efficacy were observed in both groups. Results After treatment, the levels of SCr and BUN in the observation group were significantly lower than those in the control group [(178 ± 15) μmol / L vs (278 ± 20) μmol / L, (14.9 ± 2.4) mmol / L ], p H, PaO 2 and SaO 2 were significantly higher than those in the control group [(7.9 ± 0.9) vs (7.3 ± 0.9), (89 ± 12) mm Hg (1 mm Hg = 0.133 kPa vs 71 ± 10 mm Hg, 0.95 ± 0.03 vs 0.82 ± 0.02], the difference was statistically significant (P <0.05). After treatment, the respiratory rate and heart rate in the observation group were lower than those in the control group [(18 ± 3) / min vs (25 ± 4) / min, (89 ± 8) / min vs ], Mean arterial pressure and urine output at 24 h were significantly higher than those in the control group (83.8 ± 14.2 mm Hg vs 73.4 ± 12.3 mm Hg vs 1346 ± 64 m L vs 835 ± 56 m L] Statistical significance (P <0.05). The total effective rate of observation group was higher than that of control group [88.24% (30/34) vs 67.65% (23/34)] (P <0.05). The cough improvement time, heart rate slowing time and edema disappearance time in the observation group were shorter than those in the control group [(3.0 ± 0.6) days vs (5.6 ± 1.3 days), (7.3 ± 1.2 days) vs (10.2 ± 1.7 days) 4.5 ± 0.4) d (6.9 ± 1.2) d], the difference was statistically significant (P <0.01). Conclusion Continuous pneumonitis treatment in patients with severe pneumonia complicated with multiple organ failure can significantly improve renal function, arterial blood gas indexes and vital signs of patients, which can shorten the time of improvement of clinical symptoms and have good clinical efficacy.