血管外肺水指标在脓毒症合并急性肺损伤／急性呼吸窘迫综合征患者中的作用  

Research in the role of extravascular lung water in patients with sepsis-induced ALI/ARDS

作　　者：黄昭[1] 陈裕胜[1] 杨自力[1] 刘继云[1] 

机构地区：[1]广州市第一人民医院危重症监护中心,510180

出　　处：《中华急诊医学杂志》2012年第3期244-248,共5页Chinese Journal of Emergency Medicine

摘　　要：目的应用PiCCO技术监测并比较脓毒症合并急性肺损伤（ALI）或急性呼吸窘迫综合征（ARDS）患者的血流动力学改变，以探讨血管外肺水与各肺损伤指标及肺内炎症因子水平的相关性。方法选取40例2009年至2010年广州市第一人民医院ICU住院脓毒症患者进行观察，其中未合并ALI／ARDS的患者作为对照组。应用PiCCO技术连续7d监测血管外肺水等血流动力学指标，并记录血气分析结果、呼吸机参数、胸片，检测血清及肺泡灌洗液中炎症因子白介素-1（IL-1）及肿瘤坏死因子-α（TNF—α）的水平。结果在40例脓毒症患者中，15例（37．5％）合并ARDS，14例（35％）合并ALl。与对照组相比，ALI及ARDS患者表现为显著增高的血管外肺水指数（EVLWI）及肺泡灌洗液中IL-1、TNF-α水平。同时，血管外肺水指数与氧合指数、肺损伤指数及IL-1、TNF—α水平呈显著相关性（r=-0．524，r=0．147，r=0．572，r=0．655；P〈0．05），且高ELVW水平组患者ICU病死率及住院病死率均显著高于低ELVW水平组。结论在脓毒症介导的ALl及ARDS患者中，血管外肺水指标与肺内炎症因子水平及肺损伤严重程度具有相关性。凼此，EVLw的检测可能对于判断脓毒症患者肺损伤程度及预后具有一定意义。Objective To investigate and compare the change of extravascular lung water （EVLW） and levels of cytokines in septic patients without clinical acute lung injury （ALI） /acute respiratory distress syndrome （ARDS） with those in spetic patients with sepsis-induced ALL/ARDS in order to determine the role of EVLW involved in the pathogenesis of lung injury in the patients by quantifying the relationship between EVLW and hiomarkers of lung injury in patients with sepsis. Methods A total of 40 septic patients complicated either with or without clinical ALI/ARDS after sepsis. In each patient, transpulmonary thermodilntion （PiCCO） was used to measure cardiovascular hemodynamics and EVLWI for 7 days via an arterial cannula indwelled within 72 hours after diagnosis of severe sepsis was made, and serial bronchoalveolar lavages （BAL） were carried out. Other examinations including blood gas analysis, ventilator parameters, chest X-ray and the levels of pro-inflammatory cytokines such as tumor necrosis factor （TNF-α）, interleakin-1 in the BAL were recorded. In-hospital and ICU mortalities were also observed. Results Of totai 40 patients, 29 were complicated with clinically defined septic ALI/ARDS （ ARDS n = 15, and ALI n = 14）. The septic patients complicated with ALI/ARDS had significantly higher amount of EVLWI and higher levels of TNF-α and interleukin-1 in the BAL than patients without ALI/ARDS （P 〈 0. 05）. The arterial oxygen tension/fractional inspired oxygen ratio, lung injury score, and the levels of TNF-α, IL-l in the BAL correlated with EVLWI. Moreover, in-hospital mortality, ICU mortality and the length of ICU stay of the patients with high amount of EVLWI were markedly increased than those of patients with low amount of EVLWI. Conclusions In septic patients complicated with ALI/ARDS, the extravascular lung water index correlates with oxygenation, lung injury severity and inflammatory cytokines in lung. Determination of EVLWI may be useful for evaluation of severity of lung injury

关 键 词：脓毒症 急性肺损伤 急性呼吸窘迫综合征 血管外肺水 细胞因子 

分 类 号：R563.8[医药卫生—呼吸系统]