急性肺损伤患者液体管理的临床研究

目的 探讨急性肺损伤(ALI)患者不同液体管理策略与预后及肺力学特征的关系.方法 选择我科2007-07～2009-06收治的42例ALI病例,随机分为限制性液体管理组和非限制性液体管理组,依中心静脉压(CVP)水平实施液体管理,试验观察持续7 d.比较两组患者治疗前和治疗第2天的氧合指数、肺损伤评分、呼吸力学及28 d使用呼吸机时间、28 d住ICU时间、60 d病死率.结果 治疗第2天,限制性液体管理组较非限制性液体管理组氧合指数上升,肺损伤评分降低,呼吸力学指标中气道峰压、气道阻力降低,肺顺应性升高(P<0.05);限制性液体管理组28 d使用呼吸机时间、28 d住ICU时间均显著低于非限制性液体管理组(P<0.05),60 d病死率亦较非限制性液体管理组显著下降(P<0.05).两组肾衰竭发生率比较差异无统计学意义.结论 限制性液体管理策略有助于改善ALI患者预后.

Study on the strategy of liquid management for ALI patient

Objective To investigate the effect of different fluid managements on the prognosis of patients with acute lung injury (ALI).Methods 42 patients with ALI were enrolled in the study and were divided randomly into 2 groups:liberal and conservative strategy, respectively.We monitored the death at 60 days, the days of using ventilator, days in the intensive care unit, the change of PaO_2/FiO_2, ALI score, PIP, RAW and CL.Results The death at 60 days was lower in conservative strategy than in liberal strategy.Compared with the liberal strategy, the oxygenation index improved, the lung injury score,the days of using ventilator and days in the intensive care unit decreased in the conservative strategy(P<0.05).The incidences of kidney failurehad no statistical difference.Conclusion A conservative strategy of fluid management may be better for ALI patients than liberal strategy.