人感染H7N9禽流感并发急性呼吸窘迫综合征患者血管外肺水指数变化研究  

Study of changes in extravascular lung water index of patients suffered from H7N9 avian influenza with acute respiratory distress syndrome

作　　者：聂成[1] 曾振国[1] 左玮[2] 肖声平[3] 江榕[1] 温桂兰[2] 张伟[2] 钱克俭[1] 

机构地区：[1]南昌大学第一附属医院重症医学科,江西330006 [2]南昌大学第一附属医院呼吸内科,江西330006 [3]南昌大学第一附属医院急诊科,江西330006

出　　处：《中华危重病急救医学》2013年第8期460-462,共3页Chinese Critical Care Medicine

基　　金：江西省科技计划项目（赣财教[2011]83号）

摘　　要：目的 分析人感染H7N9禽流感并发急性呼吸窘迫综合征（ARDS）患者血管外肺水指数（EVLWI）的变化特点,探讨EVLWI与患者肺损伤严重程度、肺氧合功能的关系.方法 南昌大学第一附属医院2013年4月至6月收治4例人感染H7N9禽流感患者,其中并发重度ARDS患者实施小潮气量联合呼气末正压（PEEP）的保护性通气策略,并采用脉搏指示连续心排血量（PiCCO）技术监测血流动力学参数和EVLWI.机械通气期间采集患者PEEP、吸入氧浓度（FiO2）、动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）、心排血指数（CI）、外周血管阻力指数（SVRI）、肺血管阻力指数（PVRI）、EVLWI、中心静脉压（CVP）.结果 4例H7N9禽流感患者入院时均并发ARDS,其中2例并发重度ARDS患者实施保护性机械通气为主的综合治疗,这2例患者机械通气时间分别为9d与30 d,分别实施PiCCO监测9d和21 d；机械通气开始后1、2、3 d EVLWI（ml/kg）分别为10.0±3.2、12.0±2.9、14.0±4.2和24.0±6.7、24.0±6.1、23.0±5.8,随着病情好转,EVLWI逐渐下降,撤离机械通气时分别降至5.5±2.7和7.0±3.0;PEEP、FiO2逐渐下凋,PaO2/FiO2逐渐上升,撤离机械通气时PaO2/FiO2（mm Hg,l mm Hg=0.133 kPa）分别升高至334±64和142±53；CI、SVRI、PVRI、CVP则无显著变化.结论 人感染H7N9禽流感患者并发重度ARDS时EVLWI明显增加；随着患者病情逐渐好转,EVLWI逐渐恢复正常.EVLWI动态变化与ARDS严重程度、肺氧合功能存在相关性.Objective To analyze the characteristic of changes in extravascular lung water index （EVLWI） of H7N9 avian influenza patients who complicated with acute respiratory distress syndrome （ARDS）,and to approach the relevance between EVLWI and severity,pulmonary oxygenation in patients with lung injury.Methods Four H7N9 avian influenza patients administered from April to June in 2013 in First Affiliated Hospital of Nanchang University were studied.The patients who suffered from severe ARDS were administered with low tide volume ventilation plus positive end-expiratory pressure （PEEP）,namely protected ventilation strategy,with monitoring hemodynamic parameters and EVLWI through pulse-indicated continuous cardiac output （PiCCO） catheter.During ventilation,patients＇ parameters,such as PEEP,fraction of inspired oxygen （FiO2）,arterial partial pressure of oxygen （PaO2）,oxygenation index （PaO2/FiO2）,cardiac index （CI）,systemic vascular resistance index （SVRI）,pulmonary vascular resistance index （PVRI）,EVLWI,and central venous pressure （CVP） were collected.Results All 4 H7N9 avian influenza patients were complicated with ARDS,2 patients were classified to severe ARDS and administered with comprehensive therapies,specially protected ventilation strategy; ventilation duration was 9 days and 30 days respectively,and PiCCO monitoring was 9 days and 21 days respectively.EVLWI （ml/kg） of 2 patients on the 1 st,2nd,3rd day was 10.0 ± 3.2,12.0 ± 2.9,14.0 ±4.2,and 24.0 ± 6.7,24.0 ± 6.1,23.0 ± 5.8,respectively.As their conditions became better,patients＇ EVLWI decreased to 5.5 ± 2.7 and 7.0 ± 3.0,respectively at weaning.PEEP and FiO2 of 2 patients were down-regulated,PaO2/FiO2 （mm Hg,1 mm Hg=0.133 kPa） increased to 334 ±64 and 142 ±53 at weaning.However,no significant changes in CI,SVRI,PVRI and CVP in the 2 patients were observed.Conclusions EVLWI increases when H7N9 avian influenza patients are complicated with severe ARDS.As the conditions get better,EVLWI returns to no

关 键 词：人感染H7N9禽流感 急性呼吸窘迫综合征 血管外肺水指数 肺氧合功能 病情程度 

分 类 号：R563.8[医药卫生—呼吸系统]