摘要
目的探讨连续性血液净化（CBP）治疗改善危重哮喘患者肺机械通气参数、细胞因子水平、血气分析结果的机制。比较应用碳酸氢盐置换液与乳酸盐置换液在以上方面的差别。方法26例危重哮喘患者按随机数字表法分为对照组（10例）、碳酸氢盐CBP组（8例）、乳酸盐CBP组（8例），分别应用单纯机械通气、机械通气＋碳酸氢盐置换液CBP、机械通气＋乳酸盐置换液CBP治疗24h，比较3种治疗方法对肺机械通气参数、血清细胞因子、血气分析、动脉血乳酸、电解质的影响。结果碳酸氢盐CBP组、乳酸盐CBP组治疗24h后肺机械通气参数改善，细胞因子水平下降，pH值及氧分压得到改善；两种置换液对血清电解质、动脉血氧分压（PaO2）、动脉血乳酸无明显影响。乳酸盐CBP组pH值明显高于碳酸氢盐CBP组（7．39±0．05比7．30±0．01，P〈0．01），动脉血二氧化碳分压（PaCO2，mmHg，1mmHg=0．133kPa）明显低于碳酸氢盐CBP组（57．14±5．04比89．00±3．66，P〈0．01）。结论联合应用CBP治疗危重哮喘可以更快改善肺机械通气参数和血气分析结果，迅速降低细胞因子水平；乳酸盐置换液可以更好地改善CO2潴留。
Objective To explore the mechanism that continuous blood purification （CBP） improve the lung mechanical ventilation parameters, cytokine levels and blood gas analysis results in severe asthma patients, and compare the differences in those parameters between bicarbonate and lactate displacement liquid. Methods According to the random number table, 26 severe asthma patients were allocated into control group （n = 10）, bicarbonate group （n =8） and lactate group （n =8）. Twenty-four hours treatment with mechanical ventilation （control group）, mechanical ventilation ± CBP （bicarbonate group） or mechanical ventilation ± CBP （lactate group） were conducted respectively. Lung mechanical ventilation parameters, serum cytokine level and blood gas analysis results, arterial blood lactate, and electrolytes level were compared among groups. Results After 24-hour CBP, the lung mechanical ventilation parameters were improved, cytokine levels were decreased, and pH value and partial pressure of oxygen were improved in bicarbonate group and lactate group. The two kinds of displacement liquid had no influence in arterial partial pressure of oxygen （PaO2）, arterial blood lactate, and serum electrolytes level. The pH value in lactate group was higher than that in bicarbonate group （7.39 ± 0.05 vs. 7.30 ± 0.01, P〈0.01 ）. The arterial partial pressure of carbon dioxide （PaCO2, mm Hg, 1 mm Hg=0.133 kPa） was lower in lactate group than that in bicarbonate group （57.14 ± 5.04 vs. 89.00 ± 3.66, P〈0.01 ）. Conclusions Combine CBP might improve the lung mechanical ventilation parameter, cytokine level and blood gas analysis more quickly in severe asthma treatment. The lactate displacement liquid improves the retention of carbon dioxide more.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2012年第11期665-669,共5页
Chinese Critical Care Medicine
基金
国家重点基础研究发展计划（973）项目（2009CB522702）
天津市医药卫生科技基金项目（09KY05）
关键词
危重哮喘
连续性血液净化
肺机械参数
细胞因子
Severe asthma
Continuous blood purification
Lung mechanical ventilation parameter
Cytokine
