中心静脉压、全心舒张末期容积指数和血管外肺水指数在评估脓毒性休克液体复苏中的作用

目的分析中心静脉压（CVP）与全心舒张末期容积指数（GEDI）和血管外肺水指数（ELWI）在脓毒性休克患者液体复苏中
的作用。方法对46例脓毒性休克患者（共367组数值）进行液体复苏，测定并记录CVP、GEDI和ELWI三个参数，再对这些参
数进行回归性分析，研究其相关性，探讨其在液体复苏中的作用。结果对于脓毒性休克患者，CVP与GEDI呈微弱线性相关性
（r=0.137，P=0.009）；进一步分层，当CVP<8 mmHg时，两者呈微弱线性相关性（r=0.149，P=0.029）；当8 mmHg≤CVP≤12 mmHg
和CVP>12 mmHg时，两者均无线性相关性（r分别为0.075、0.049，P分别为0.462、0.726）。367组数据，CVP与ELWI无线性相
关性（r=0.040，P=0.445）。再进一步分层，当CVP<8 mmHg时，两者呈微弱线性相关性（r=0.221，P=0.001）；当8 mmHg≤CVP≤
12 mmHg和CVP>12 mmHg时，两者均无线性相关性（r 分别为-0.047、0.042，P分别为0.646、0.765）。结论脓毒性休克患者
CVP和GEDI、CVP和ELWI之间均无显著线性相关性。CVP不能准确评估有效循环血容量和肺水肿程度。

Role of central venous pressure,global end diastolic volume index and extravascular lung water index in evaluating fluid resuscitation in patients with septic shock

Objective To explore the role of central venous pressure (CVP), global end diastolic volume index (GEDI) and
extravascular lung water index (ELWI) monitoring in patients with septic shock during fluid resuscitation by pulse induced
continuous cardiac output (PiCCO) test. Methods Forty-six patients with severe sepsis and septic shock were enrolled in this
study. Hemodynamic monitoring was performed during fluid resuscitation and the data including CVP, GEDI and ELWI were
collected to analyze their relationship and the clinical values. Results In patients with septic shock, CVP showed a weak linear
correlation with GEDI during fluid resuscitation (r=0.137, P=0.009). In the subgroups stratified with CVP cut-off values of 8
mmHg and 12 mmHg, the correlation coefficient between CVP and GEDI was 0.149 (P=0.029) in CVP<8 mmHg group, 0.075 (P=
0.462) in 8 mmHg≤CVP≤12 mmHg group, and 0.049 (P=0.726) in CVP>12 mmHg group. In the total of 367 data groups
obtained, CVP showed no linear correlation with ELWI (r=0.040, P=0.445). In the CVP subgroups, CVP and ELWI were weakly
correlated in CVP<8 mmHg group (r=0.221, P=0.001), but they showed no correlations in 8 mmHg≤CVP≤12 mmHg and CVP>
12 mmHg groups (r=-0.047, P=0.646; r=0.042, P=0.765). Conclusion There is no significant linear correlation between CVP and
GEDI or between CVP and ELWI in patients with septic shock. CVP can not reflect the circulatory blood volume or the degree
of pulmonary edema.