亚低温处理联合血液净化治疗重症监护室低心排出量综合征患者的临床效果研究

摘要

Objective To investigate the clinical effect of sub - hypothermia treatment combined with hemopurification on low cardiac output syndrome(LCOS)in ICU. Methods From August 2010 to February 2015,a total of 74 patients with LCOS were selected in the ICU,Fuxing Hospital Affiliated to Capital Medical University,and they were divided into control group and treatment group according to the principle of lottery, each of 37 cases. Patients of the two groups received hemopurification treatment after admission,meanwhile patients of control group received warming treatment for hemofiltration apparatus,while patients of treatment group received sub - hypothermia treatment for hemofiltration apparatus. ICU stays, duration of mechanical ventilation,anal temperature after 6 hours,24 hours and 72 hours of treatment,APACHE Ⅱ score and MODS score before treatment and after 72 hours of treatment,and incidence of complications during treatment were compared between the two groups. Results ICU stays and duration of mechanical ventilation of treatment group were statistically significantly shorter than those of control group( P < 0. 05 ),while anal temperature of treatment group was statistically significantly lower than that of control group after 6 hours,24 hours and 72 hours of treatment,respectively(P < 0. 05). No statistically significant differences of APACHE Ⅱ score or MODS score was found between the two group before treatment(P >0. 05);after 72 hours of treatment,APACHE Ⅱ score and MODS score of treatment group were statistically significantly lower than those of control group(P < 0. 05),and APACHE Ⅱ score and MODS score of the two groups were statistically significantly lower than those before treatment( P < 0. 05). The incidence of chills,electrolyte disturbance,coagulation disorders and arrhythmia was statistically significantly lower than those of control group,respectively( P < 0. 05). Conclusion Sub -hypothermia treatment combined with hemopurification is helpful to maintain the function of organs and improve the circulatory function of patients with LCOS in ICU,can promote the recovery with relatively high safety.%目的：探讨亚低温处理联合血液净化治疗重症监护室（ICU）低心排出量综合征（LCOS）患者的临床效果。方法选取2010年8月—2015年2月首都医科大学附属复兴医院 ICU 收治的 LCOS 患者74例，根据抽签原则随机分为对照组和治疗组，每组37例。两组患者均给予血液净化治疗，对照组患者在血液净化期间对血滤机进行加温处理，治疗组患者在血液净化期间对血滤机进行亚低温处理。比较两组患者 ICU 入住时间，呼吸机辅助时间，治疗6、24、72 h 肛温，治疗前及治疗72 h 急性生理学及慢性健康状况评价系统Ⅱ（ APACHE Ⅱ）评分、多器官功能不全（MODS）评分，治疗期间并发症发生情况。结果治疗组患者 ICU 入住时间和呼吸机辅助时间均短于对照组（ P <0.05）。治疗组患者治疗6、24、72 h 肛温均低于对照组（P <0.05）。治疗前，两组患者 APACHE Ⅱ评分与 MODS 评分比较，差异无统计学意义（P >0.05）；治疗72 h，治疗组患者 APACHE Ⅱ评分与 MODS 评分均低于对照组（ P <0.05）；两组患者治疗72 h APACHE Ⅱ评分与 MODS 评分均低于治疗前（P <0.05）。治疗组患者寒颤、电解质紊乱、凝血功能异常、心律失常发生率均低于对照组（P <0.05）。结论亚低温处理联合血液净化治疗有助于维持 ICU LCOS患者器官正常功能，改善患者循环功能，促进患者康复，且安全性较高。