不同液体管理策略对急性呼吸窘迫综合征患者血管外肺水指数的影响  

Effect of different fluid - management strategies on extravascular lung water index in the patients with acute respiratory distress syndrome

作　　者：孙晓义[1] 王心杰 张芝晶[1] 

机构地区：[1]大连市中心医院急诊科,辽宁116021

出　　处：《中国急救医学》2011年第9期781-785,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的通过观察不同液体管理策略对急性呼吸窘迫综合征（ARDS）患者血管外肺水指数（EVLWI）、氧合指数（PaO2／FiO2）、24h液体平衡量、机械通气时间、住ICU时间的影响，探寻ARDS患者的最佳液体管理策略。方法选取符合人选标准的ARDS患者为研究对象，随机分为保守性液体管理策略组（保守组）和开放性液体管理策略组（开放组），动态监测中心静脉压（CVP）、平均动脉压（MAP）、心脏指数（CI）、PaO2／FiO2、尿量及EVLWI等，记录24h液体平衡量、机械通气时间及住ICU时间。结果保守组除第1天外每日液体均处于负平衡，而开放组每日液体均处于正平衡。保守组EVLWI下降程度、PaO2／FiO2改善程度明显好于开放组，机械通气时间、住ICU时间明显短于开放组（P均〈0．05）。结论保守性液体管理策略可以明显降低ARDS患者血管外肺水，改善肺功能，缩短ARDS患者机械通气时间和住ICU时间。保守性液体管理策略是降低血管外肺水的有效治疗手段。Objective To investigate the effect of different fluid - management strategies on extravascular lung water index （EVLWI） , PaO2/FiO2, 24 -hour fluid balance, mechanical ventilation days, ICU days in ARDS patients and to find the optimal fluid management in patients with acute lung injury（ALI）. Methods Acute respiratory distress syndrome （ARDS） patients who met the inclusion criteria were selected as research objects. They were randomly assigned to conservative fluid - management strategy group and liberal fluid - management strategy group. Central venous pressure （CVP）, mean arterial pressure （MAP）, cardiac index（ CI）, PaO/FiO2, urinary output and EVLWI were measured. The volume of 24 - hour fluid balance, mechanical ventilation days and ICU days were recorded. Results Fluid balance volumes of conservative group were negative except the 1 st day, but those of liberal group were all positive. The reduce of patients＇EVLWI was faster and the improvement of PaO2/FiO2 was better in conservative group than in the liberal group. Mechanical ventilation days and ICU days were shorter in conservative group than in liberal group patients. Conclusion The conservative fluid- management strategy can reduce ARDS patients EVLW, improve the pulmonary function, reduce ARDS patients mechanical ventilation days and ICU days. The conservative fluid management strategy is an effective approach to reduce EVLW.

关 键 词：急性呼吸窘迫综合征 液体治疗 血管外肺水 

分 类 号：R563.8[医药卫生—呼吸系统]