摘要：
Objective To investigate the optimal time of initiation of continuous renal replacement therapy (CRRT) in patients with acute respiratory distress syndrome (ARDS).Methods Forty-eight patients with ARDS were randomly divided into two groups: early CRRT group ( within 24 hours after ARDS onset ) and late CRRT group ( 24 hours after ARDS onset ) .Ventilation parameter , including PaO2/FiO2 , positive end expiratory pressure ( PEEP ) , plateau pressure ( Pplat ) and hemodynamic parameters including central venous pressure ( CVP ) , mean arterial pressure ( MAP ) , blood lactic acid ( Lac) between the early and the late CRRT groups were observed at the time points of 0 h, 2 days later and 7 days later.Fluid balance, the duration of total mechanical ventilation , intensive care unit ( ICU) stay, and the 28-day mortality rate were assessed .Results There were statistical increases in PaO2/FiO2 , MAP and statistical decreases in PEEP , Pplat, Lac, and CVP from 2 days after the treatment in the patients of the early CRRT group .Furthermore, there were significantly differences in those indicators between two groups at 2 days and 7 days.The duration of total mechanical ventilation and ICU stay of the early CRRT group were (8.5 ±3.1) days and (12 ±2) days respectively, both significantly shorter than that of the late CRRT group [(14.4 ±4.1) days and (19 ±5) days,P<0.05].The 28 -day mortality rate between the two groups were 20.83 ％ vs37.5％(P <00.5). Conclusion CRRT within 24 hours can improve oxygenation , shorten the duration of mechanical ventilation and ICU stay , decrease mortality in ARDS patients, and is associated with favorable clinical outcomes in ARDS patients .%目的 观察不同时机连续性肾脏替代治疗(CRRT)对急性呼吸窘迫综合征(ARDS)的影响,探讨ARDS患者应用CRRT的时机.方法 48例中重度ARDS患者随机分为早期CRTT组(入ICU24 h内行CRRT)和晚期CRRT组(入ICU 24 h后行CRRT),每组24例,分别在治疗前和治疗后第2天、第7天监测氧合指数(PaO2/FiO2)、呼气末正压(PEEP)、平台压(Pplat)以及中心静脉压(CVP)、平均动脉压(MAP)、血乳酸(Lac)和去甲肾上腺素使用剂量,并进行比较;对两组患者液体总负荷、机械通气时间、住ICU时间及28 d病死率也进行比较.结果 早期CRRT组患者PaO2/FiO2、PEEP、Pplat、CVP、MAP在治疗后第2天即出现明显改善,Lac在治疗后第2天出现明显下降;而晚期CRRT组患者上述指标的改善及Lac的下降均晚于早期CRRT组,且在治疗后第2天、第7天两组上述指标比较差异有统计学意义.两组机械通气时间分别为(85.±3.1)d和(14.4±4.1)d(P<0.05),住ICU时间分别为(12±2)d和(19±5)d(P<0.05)2,8 d病死率分别为208.3％和375.％(P<00.5).结论 CRRT可以改善ARDS患者临床预后2,4 h内行CRRT治疗能尽早地改善氧合,稳定血流动力学,缩短机械通气时间和住ICU时间,降低病死率.
