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目的:观察连续性静脉-静脉血液滤过(CVVH)联合机械通气治疗高原肺水肿患者的临床疗效。方法:选择入住ICU符合高原肺水肿诊断标准的患者56例,随机分为2组:A组27例,采用常规治疗+机械通气;B组29例,采用常规治疗+机械通气+CVVH。分别观察2组患者在氧合指数、吸入氧浓度、动脉血氧分压、PEEP水平、心率、血压及病死率等方面的差别。结果:B组患者加用CV-VH后,各项指标经统计学处理显示:病死率,B组与A组比较,差别有显著性意义(P<0.05):其他指标B组与A组比较,差别均有高度显著性意义(P<0.01)。结论:CVVH疗法可有效清除高原肺水肿患者血管外肺水和各种应激激素、致炎介质,明显改善了高原肺水肿患者肺部氧合功能及血流动力学指标,提高抢救成功率。
Objective: To observe the clinical efficacy of continuous venovenous hemofiltration (CVVH) combined with mechanical ventilation in the treatment of patients with high altitude pulmonary edema. Methods: Fifty-six patients with ICU who met the diagnostic criteria of high altitude pulmonary edema were randomly divided into two groups: 27 cases in group A received conventional therapy and mechanical ventilation, and 29 cases in group B received routine therapy plus mechanical ventilation and CVVH. The differences of oxygenation index, inspired oxygen concentration, arterial oxygen tension, PEEP, heart rate, blood pressure and mortality were observed in the two groups. Results: After treatment with CV-VH in group B, all the indexes were statistically analyzed. The mortality rate was significantly higher in group B compared with group A (P <0.05). The other indexes in group B were compared with those in group A , The differences were highly significant (P <0.01). Conclusion: CVVH can effectively remove extravascular lung water, various stress hormones and proinflammatory mediators in patients with high altitude pulmonary edema, significantly improve pulmonary oxygenation and hemodynamics in patients with high altitude pulmonary edema, and improve the success rate of rescue.