血管外肺水监测对脓毒症急性肾损伤的应用研究

目的探讨血管外肺水监测(PICCO)在脓毒症合并急性肾损伤肾脏替代治疗(RRT)中的应用价值。方法选取2012年3月-2014年12月我院收治的脓毒症合并急性肾损伤患者41例,在PICCO监测下,予每天6~8hRRT,根据血管外肺水指数(EVLWI)值分成观察组(EVLWI7mL/kg)21例和对照组(EVLWI≤7mL/kg)20例。观察初始液体复苏治疗后,两组患者氧合指数(PO_2/FiO_2)、动脉氧分压(PO_2)、经皮脉氧饱和度(SPO_2)、血乳酸值的变化。结果观察组液体复苏24h的PO_2/FiO_2明显低于治疗前及对照组(P0.05);观察组在液体复苏48h后PO_2/FiO_2开始恢复,但仍低于对照组(P0.05);两组患者液体复苏72h的PO_2/FiO_2恢复正常。观察组液体复苏24h的PO_2低于观察组(P0.05)。两组患者液体复苏24h的SPO_2均呈一过性下降,48h恢复正常,两组患者SPO_2液体复苏治疗前后及相互比较均无统计学差异(P0.05)。观察组与对照组液体复苏24h的血乳酸明显低于治疗前(P0.01),两组间比较差异无统计学意义(P0.05)。结论血管外肺水监测有助于脓毒症合并急性肾损伤患者氧合情况的观察与护理。

Nursing for patients with acute kidney injury induced by sepsis by extravascular lung water monitoring

Abstract Objective To study the application value of pulmonary water monitoring for the treatment of renal re-placement therapy(RRT)for patients with sepsis and acute kidney injury.Method 41 patients with sepsis combined by acute kidney injury were selected in our hospital from December 2014 to March 2012.They was given 6~8 h RRT per day.According to the extravascular lung water index(EVLWI),They was divided into observation group(EVL-WI>7 mL/kg)and control group (EVLWI≤7 mL/kg).The changes of blood lactic acid value with oxygenation in-dex (PO2/FiO2 ),arterial oxygen pressure(PO2 ),percutaneous arterial oxygen saturation (SPO2 )was observed af-ter initial fluid resuscitation for the two groups.Result The PO2/FiO2 of 24 h in the observation group was signifi-cantly lower than that before treatment and the control group (P < 0.05);The PO2/FiO2 recovery in observation group was began after 48 hours of liquid recover,But still lower than that of the control group (P < 0.05);PO2/FiO2 of the two groups of patients with fluid resuscitation 72 h returned to normal.PO2 of 24h liquid recovery in ob-servation group lower than the control group (P < 0.05).SPO2 of the two groups of patients with fluid resuscita-tion showed a transient decline and returned to normal after 48 h.There was no significant difference in the two groups of patients before and after SPO2 fluid resuscitation (P > 0.05).Compared with observation group and con-trol group,the blood lactic acid of fluid resuscitation 24 h was significantly lower than before treatment P < 0.01), there was no significant difference between the two groups (P > 0.05).Conclusion The observation and nursing for patients with sepsis combined with acute kidney injury can be assisted by extravascular lung water monitors.