急性呼吸窘迫综合症患者的液体管理  

Clinical study on the strategy of fluid management for ARDS patients

作　　者：董化江[1] 罗悦晨[2] 高富合[1] 李国强[1] 刘阳[1] 曹文理[1] 张晶晶[1] 李强[1] 魏路清[1] 

机构地区：[1]武警医学院,天津300162 [2]天津医科大学,天津300700

出　　处：《武警医学院学报》2011年第7期535-537,共3页Acta Academiae Medicinae CPAPF

摘　　要：【目的】探讨急性呼吸窘迫综合症(acute respiratory distress syndrome,ARDS)患者限制液体策略与患者预后及肺力学特征的关系。【方法】42例ARDS病例,随机分为限制性液体管理组和对照组,依血管外肺水指数(extravascular lung water index,EVLWI)、胸内液体容量指数(intrathoracic blood volume index,ITBVI)水平实施液体管理,试验观察持续60 d。比较两组患者治疗前和治疗后氧合指数(PaO2/FiO2)、肺损伤评分、气道峰压(peak pressure,Ppeak)及入住ICU时间、病死率等指标。【结果】限制性液体管理组较对照组氧合指数上升,肺损伤评分降低,呼吸力学指标中气道峰压降低(P<0.05);限制性液体管理组入住ICU时间均显著低于非限制性液体管理组(P<0.05),60 d病死率低于非限制性液体管理组(P<0.05)。【结论】限制性液体管理策略有助于改善ARDS患者预后。[Objective] To investigate the effect of different fluid managements on the prognosis of patients with ARDS. [Methods]A total of 42 patients with ARDS were enrolled in the study and were divided randomly into 2 groups： liberal and limited strategy respectively. We monitored the death at 60 days, the days of using ventilator, days in the intensive care unit, the change of PaO2 / FiO2, ARDS score, Peak pressure and so on. [Results] The death at 60 days was lower in limited strategy than in liberal strategy. Oxygenation index improved, so do the lung injury score, the days of using ventilator and days in the intensive care unit decreased in the limited strategy as compared with the liberal strategy （P〈0.05）. [ Conclusion ] A limited strategy of fluid management may be better for ARDS patients than liberal strategy.

关 键 词：急性呼吸窘迫综合症 液体管理 血管外肺水指数 胸内液体容量指数 

分 类 号：R563.8[医药卫生—呼吸系统]