毛细血管渗漏综合征的易患因素分析  

Analysis of risk factors for capillary leak syndrome in ICU

作　　者：苏俊 王锦权 陶晓根 刘宝 莫宝定 

机构地区：[1]安徽医科大学附属省立医院重症医学科,合肥230001

出　　处：《中国急救医学》2011年第10期872-875,共4页Chinese Journal of Critical Care Medicine

基　　金：安徽省卫生厅医学科研课题（No.09A012）

摘　　要：目的探讨重症医学科毛细血管渗漏综合征（CLS）的发病情况和易患因素。方法重症医学科收治的2690例患者中出现CLS191例，记录入院时和出现CLS时患者血生化指标、血常规、动脉血气分析和尿常规等结果，并记录采血时患者的生命体征，以及中心静脉压（CVP）、平均动脉压（MAP）等监测结果，据此进行第二代急性生理学及慢性健康状况评估（APACHEⅡ）、多器官功能障碍综合征（MODS）和全身性炎症反应综合征（SIRS）评分。将人院时、出现CLS时的各项临床资料相比较，进行CLS易患因素分析。结果重症医学科中CLS发生率为7．10％。和入院时相比，出现CLS时患者体温升高（P〈0．01），呼吸频率增快（P〈0．05），白细胞计数和中性粒细胞百分率也升高（P〈0．01），血小板计数下降（P〈0．01）；尿pH升高（P〈0，01）；吸人氧浓度增加（P〈0．01），氧合指数下降（P〈0．05），压力调整心率降低（P〈0．01）；血清钙离子浓度和阴离子间隙下降（P〈0．05），血渗透压升高（P〈0．01）；血清谷丙转氨酶、谷草转氨酶和谷氨酰转肽酶等升高（P〈0．01和P〈0．05）。出现CLS时患者SIRS评分、APACHEⅡ评分、MODS评分均较入院时升高（P〈0．01）。结论CLS在重症患者中发生率并不低，全身性炎症反应加重、原发病恶化、血小板减少和低钙血症等是CLS常见的易患因素；出现CLS后，肝、肾等重要脏器功能也将受到不利影响。Objective To investigate the incidence and risk factors of capillary leak syndrome （CLS） in ICU. Methods There were 191 cases with CLS from 2690 patients in ICU. The score of APACHE 11 , MODS and SIRS was recorded according to blood biochemistry, arterial blood gas analysis, urinalysis, vital signs of patients and CVP on admission and occurrence of CLS. Compared the clinical data on admission with that when CLS occurred and analyzed the risk factors of CIS. Results The incidence rate of CLS in ICU was 7.10%. Compared with the clinical data on admission, When CLS occurred, their temperature was higher （ P 〈 0. 01 ）, respiratory rate was faster （ P 〈 0. 05 ）, white blood cell count and neutrophil percentage increased （P 〈 0.01 ）, blood platelet count decreased （P 〈 0.01 ）, urinary pH and inspired oxygen concentration increased （ P 〈 0. 01 ）, the oxygenation index and pressure - adjusted heart rate decreased （P 〈 0. 05, 0.01 ）, serum calcium concentrations and anion gap decreased （ P 〈 0. 05 ）, blood osmotic pressure increased （ P 〈 0. 01 ）, serum alanine aminotransferase, aspartate aminotransferase and glutamyl transpeptidase was higher（ P 〈 0.01,0.05 ）. The score of SIRS, APACHE Ⅱ and MODS is higher （ P 〈 0.01 ）. Conclusions The incidence rate of CLS was not rarely in critically ill patients. The common risk factors of CLS were increased systemic inflammation, aggravated the primary disease, thrombocytopenia, hypocalcemia and so on. The function of liver, kidney and other important organ would be injured when CLS occurred.

关 键 词：毛细血管渗漏综合征 发病情况 易患因素 重症医学科 

分 类 号：R654.1[医药卫生—外科学]