Effect Of Continuous Renal Replacement Therapy On The Patients With Acute Respiratory Distress Syndrome

Objective:To observe the effect of continuous renal replacement therapy(CRRT)on the plasma cytokine,extravasculur lung water,lung function in patients with acute respiratory distress syndrome (ARDS).To explore CRRT on the treatment of ARDS.Method:32 ARDS patients received mechanical ventilation were randomly divided into two groups,CRRT group(n=1T)and control group (n=15).The patients in the control group accepted routine treatment,while the CRRT group patients accepted routine treatment and continuous renal replacement therapy.In the CRRT group,the patients underwent continuous veno-venous hemofiltration(CVVH)for 72 hours,the ultrafiltrate volumes were 96L/24h and the blood flow was set 150～250ml/min,as well as the filter were replacement every 24 hours.At the time pretreatment and each 24h after treatmen(4 times),the changes of the plasma cytokine(TNF-α,IL-6,IL-8)were detected with Enzyme Linked Immunosorbent Assay(ELISA)and compared between two groups.The changes of the respiratory rates,arterial serum lactate,oxygenation index and the positive end-expiratory pressure level were detected and compared between two groups.The changes of the extravasculur lung water(EVLWI)and intratheraeic blood volume (ITBV)were detected with the pulse indicator continous cardiac output(PiCCO).In addition,the time of hospitalization in the intensive care unit(ICU)and hospital mortality rate were assessed for all patients.All the datas of the above are expressed by the(?)±s,all the data are record and analyzed with SPSS11.0.Results:The hospitalization in ICU(17.1±5.5d vs 21.8±6.3d) and hospital mortality rate(23.53%vs 66.67%)in the CRRT group were significantly decreased than that in the control group,there were statistical significance(p＜0.05).The plasma cytokine level of the CRRT group were significantly lower than which in the control group.72h after CVVH,it was significantly lower than pretreatment between the two groups,there were statistical significance(p＜0.01).The improvement of respiratory rates(27.1±4.0 vs 31.3±4.4)and oxygenation index (176.7±13.8 vs 154.3±15.5)in the CRRT group were significantly than that in the control group at the time 72h after CVVH,there were statistical significance(p＜0.05).The positive end-expiratory pressure (PEEP)level and arterial serum lactate(Lac)in the CRRT group were significantly decreased than that in the control group at the time 48h,72h after CVVH,there were statistical significance(p＜0.05).The extravasculur lung water(8.8±3.3 vs 11.1±2.1)and intratheraeic blood volume(1099.4±229.7 vs 1226.4±232.3)in the CRRT group were significantly decreased than that in the control group,there were statistical significance(p＜0.05)Conclusion:CRRT can effectively clear the plasma cytokine therefore block inflammatory pathogenesis in ARDS.CRRT can improve lung function,decrease extravasculur lung water and morality significantly in patients with ARDS.