急性呼吸窘迫综合征患者血管外肺水的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(EVLW)与ARDS患者预后的关系。方法根据患者预后,将23例ARDS患者分为存活组(n=13)及死亡组(n=10)。连续3 d利用PiCCO监护仪测定入选患者血管外肺水指数(EVLWI)的动态变化,并分析其与患者预后的关系。结果入院时存活组及死亡组患者除血乳酸水平外,其他动脉血气分析指标差异均无统计学意义。两组患者入ICU时EVLWI均较高[(13.9±3.45)mL/kg比(14.87±5.75)mL/kg,P>0.05],但无明显差异。在强化治疗的第2 d,存活组患者EVLWI开始明显下降,死亡组患者的EVLWI轻度上升,两组间EVLWI出现明显差异[(11.07±2.51)mL/kg比(15.63±5.05)mL/kg,P<0.05]。治疗后第3 d两组患者EVLWI间差别更加明显[(10.32±1.57)mL/kg比(16.6±4.33)mL/kg,P<0.01]。结论 ELVW的动态变化可用于评估ARDS治疗效果和患者预后,也提示EVLWI可能是客观评价肺毛细血管渗漏的指标之一。

The Prognostic Value of Extra-vascular Lung Water Index in Patients with ARDS

Objective To analyze different characteristics of extra-vascular lung water （EVLW） in the patients with acute respiratory distress syndrome （ ARDS）, and examine its prognostic value. Methods 23 patients with ARDS admitted between November 2010 and December 2011 were divided into a survival group （n = 13 ） and a dead group （n = 10 ） according to the outcome. The hemodynamic status including extravascular lung water index （EVLWI） was measured in 3 consecutive days, and the relationship between EVLWI and the prognosis of patients was analyzed. Results On the first day of diagnosis, the EVLWI was higher in both groups in comparison with normal value. It was （ 13.9 ± 3.45 ） mL/kg in the survival group and （ 14.87 ± 5.75） mL/kg in the dead group（ P 〉 0.05）. However, on the second day, the EVLWI in the survival group dropped significantly after intensive intervention, but the patients in the dead group did not respond well to the treatment and the EVLWI declined slightly. The EVLWI of both groups began to diverge significantly from each other,showing average value of （11.07 ±2.51 ）mL/kg and （15.63 ±5.05 ）mL/kg, respectively（P 〈 0.05）. On the third day,this difference between two groups was still more remarkable, resulting in （10.32±1.57）mL/kg vs. （16.6±4.33）mL/kg（P 〈0.01）. Conclusions The changes of EVLWI can be used to evaluate the effectiveness of treatment and predict the prognosis of patients with ARDS. EVLWI would likely be an indicator to evaluate the pulmonary capillary leakage.