肺挫伤患者血管外肺水指数的监测和液体管理  

Extravascular lung water index monitoring and fluid management in patients with pulmonary contusion

作　　者：彭民[1] 宋世辉[2] 周文[2] 张鹏[3] 

机构地区：[1]天津医科大学总医院ICU,300052 [2]天津医科大学总医院心内科,300052 [3]山西省人民医院胸外科

出　　处：《中国医师进修杂志》2012年第14期5-8,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的通过对肺挫伤患者血管外肺水指数（EvLwI）的监测，对患者监护中的临床指标进行评价，指导液体管理。方法选取3l例严重胸部损伤致肺挫伤患者，分别行中心静脉置管及股动脉置管，连接血流动力学监测仪，运用热稀释法测量肺挫伤后EVLWI，详细记录液体出入量，控制液体量，并应用利尿剂，评价氧合指数、EVLWI和液体平衡差值在不同时间的变化及其相关性。结果肺挫伤后EVLWI在入院后第1～7天分别为（9．25±0．71）、（8．98±0．61）、（8．61±0．59）、（7．75±0．53）、（6．64±0．49）、（6．22±0．36）、（5．59±0．39）ml／kg，入院后第3天开始EVLWI与入院后第1天比较差异有统计学意义（P〈0．05）；氧合指数在人院后第1～7天分别为（145．76±23．61）、（144．19±20．24）、（146．67±19．25）、（159．33±15．42）、（177．38±14．25）、（199．33士19．04）、（213．71±18．51）mmHg（1mmHg=0．133kPa），入院后第4天开始氧合指数与入院后第1天比较差异有统计学意义（P〈0．05）；入院后第1-7天液体均为负平衡，入院后第3—6天液体平衡差值与入院后第1天比较差异有统计学意义[（-431．43±121．17）、（-601．43±127．09）、（-629．52±140．69）、（-320．01±93．71）ml比（-213．81±63．91）ml]（P〈0．05）。氧合指数与EVLWI呈负相关（r=-0．824，P〈0．01）。液体平衡差值与EVLWI和氧合指数无相关性。结论肺挫伤后EVLWI的有效监测，不仅可用于评价肺挫伤后不同时期肺部血管通透性变化，而且在指导肺挫伤后液体管理方面有重要意义。Objective To guide fluid management and evaluate the clinical index through monitoring extravascular lung water index（EVLWI） of patients with pulmonary contusion. Methods Thirty- one severe chest trauma patients with pulmonary contusion were selected,performed with central venous catheterization or femoral artery catheterization, and connected to pulse index continuous cardiac output （PICCO）. EVLWI after pulmonary contusion were measured by using thermal dilution. The intake and output of patients were recorded in detail, fluid intake was controlled, furosemide was prescribed, and the changes and correlations of oxygenation index,EVLWI and liquid balance difference at different time points were evaluated. Results EVLWI after pulmonary contusion at 1st to 7th d after hospitalization was respectively （9.25 ± 0.71）, （8.98 ± 0.61）, （8.61 ± 0.59）, （7.75 ± 0.53）, （6.64 ± 0.49）, （6.22 ± 0.36）, （5.59 ±0.39） ml/kg. Comparing with 1 st d after hospitalization, EVLWI declined from 3rd d （P 〈 0.05 ）. Oxygenation index at 1 st to 7th d after hospitalization was respectively （ 145.76 ± 23.61 ）, （ 144.19 ± 20.24 ）, （ 146.67 ± 19.25 ）, （ 159.33 ± 15.42）, （ 177.38 ± 14.25）, （ 199.33 ± 19.04）, （213.71 ± 18.51 ） mm Hg（ 1 mm Hg = 0.133 kPa）. Comparing with 1st d,oxygenation index from 4th to 7th d had significant difference （P 〈 0.05）. The fluid volume at 1st d to 7th d were all negative balance,that of 3rd d to 6th d had significant difference comparing with 1st d [（-431.43 ± 121.17）, （-601.43 ± 127.09）, （-629.52 ± 140.69）, （-320.01 ± 93.71） ml vs. （-213.81 ± 63.91 ） ml]（P〈 0.05 ）. Oxygenation index and EVLWI had negative correlation（r = -0.824,P〈 0.01 ）. Liquid balance difference and the changes of oxygenation index and EVLWI had no correlation. Conclusion EVLWI effectively monitoring after pulmonary contusion can not only evaluate the changes of pulmonary vascular permeability of patients with pulmona

关 键 词：血管外肺水 心排血量 肺挫伤 液体管理 

分 类 号：R563.8[医药卫生—呼吸系统]