急性呼吸窘迫综合征患者血管外肺水指数动态变化与预后的关系

目的分析急性呼吸窘迫综合征(ARDS)患者血管外肺水指数(EVLWI)的变化特点,探讨其在ARDS患者液体管理中的指导意义以及对预后评估的价值。方法采用回顾性研究的方法 ,将2011年1月至12月收住湖州市第一人民医院重症监护室(ICU)的24例ARDS患者根据临床转归分为存活组(16例)与死亡组(8例),观察两组患者的临床特点,运用脉搏指示持续心输出量监护仪进行血流动力学监测。结果两组患者入住ICU第1天的一般情况、平均动脉压、中心静脉压(CVP)、氧合指数、血乳酸水平、心排指数和EVLWI差异均无统计学意义(P均>0.05)。从第1天到第3天,存活组氧合指数逐天上升,EVLWI、血乳酸值逐天降低,而死亡组三个指标均逐天降低,三个指标在两组间有统计学意义(P均<0.05)。另EVLWI与氧合指数呈明显负相关(r=-0.46,P<0.01),而EVLWI与CVP无明显相关性(r=-0.11,P=0.146)。第3天的EVLWI与预后的接受者操作特性曲线下面积为0.738±0.069,当EVLWI>8.5ml/kg时,预后评价的敏感度为85.3%,特异度为56.8%。结论 EVLWI的动态变化可用于评估治疗效果和患者预后,EVLWI可能是客观评价肺毛细血管渗漏的指标之一。

The prognostic value of the dynamic change of extravascular lung water index in patients with acute respiratory distress syndrome

Objective To observe the dynamic changes of the extravascular lung water index （EVLWI）, investigate its guiding role on fluid management and prognostic value in the patients with acute respiratory distress syndrome （ARDS）. Methods The patients with ARDS hospitalized in intensive care unit （ICU）, First People＇s Hospital of Huzhou, from January to December 2011 were enrolled in the retrospective study. The cases were divided into the survival group （16 cases） and fatal group （8 cases） according to the prognosis. The clinical features were observed and changes in hemodynamics were monitored by pulse indicated continuous cardiac output in all the patients. An association between EVLWI and the prognosis was determined. Results On admission to ICU, the patients general condition, central venous pressure, mean arterial pressure, PaO2/FiO2, lactic acid levels and EVLWI showed no statistical difference between the two groups （all P 〉 0.05）. From day 1 to day 3, the PaO2/ FiO2 obviously increased day by day, lactic acid and EVLWI levels gradually decreased in thesurvival group, whereas they showed exactly the opposite in the fatal group. Statistical significance was noted in EVLWI, PaO2 / FiO2 and central venous pressure between the two groups （oil P 〈 0.05）. A negative change of EVLWI was always associated with an increase in PaO2/FiO2 （r =-0.46, P 〈 0.01） but had no obvious correlation with central venous pressure level （r =-0.11, P= 0.146）. The area under the receiver operating characteristic curve showed that EVLWI levels at day 3 could predict prognosis （0.738 ±0.069） during ICU stay, with a prognostic sensitivity of 85.3% and specificity of 56.8% when EVLWI 〉 8.5 ml / kg. Conclusions The changes of EVLWI could assess the therapeutic effect and prognosis of the patients with ARDS. Thus, the EVLWI level can be an indicator to evaluate the pulmonary capillary leakage.