重度肺毛细血管渗漏并发严重低血容量性休克的液体复苏：附1例报告

对1例体外超声碎石时出现“呼吸困难、血压低，伴心悸、胸闷、全身大汗”临床考虑为重度肺毛细血管渗漏、低血容量性休
克的患者行脉搏波指示连续心排血量（PiCCO）技术监测，动态观察各血流动力学指标，根据血管外肺水指数（EVLWI）及全心舒
张末容积指数（GEDI）控制性补液，纠正休克治疗过程中该患者心排量（CO）和GEDI一直偏低，EVLWI最高达到了32 ml/kg，持
续可吸出大量淡红色稀薄血性痰，高呼吸机支持参数下氧饱和度仍然非常低。为纠正休克同时减轻肺水肿选择了控制性补液，
即当GEDI低于500 ml/m2时选择补充胶体液，当GEDI高于500 ml/m2时减少补液量并减慢补液速度，保持轻度容量不足并及时
调整呼吸机参数，经治疗后患者胸片肺水肿逐渐好转，乳酸，肝肾功能，逐渐好转，6 d后停用升压药，10 d后脱呼吸机并拔除经口
气管插管，25 d后顺利出院。在治疗过程中PiCCO监测有重要的指导意义。

Fluid resuscitation in a patient with severe hypovolemic shock and severe pulmonarycapillary leak

A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood
pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic
shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the
measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed
low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from
the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used
to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m2, and the volume and fluid
infusion rate were reduced for a GEDI higher than 500 ml/m2. Pulmonary edema was gradually reduced after the treatments
with improvement of lactic acid level and liver and kidney functions. Vasopressors were withdrawn 6 days later, mechanical
ventilation was discontinued 10 days later, and tracheal intubation was removed 25 days later, after which the patient was
discharged. In the treatment of the patient, PiCCO monitoring played an important role.