重症肺部感染患者强化静脉液体管理的临床研究  

Clinical study of cardiopulmonary function protection for patients with pulmonary infection through intensive fluid management

作　　者：张俭[1] 王斌[1] 徐长青[2] 

机构地区：[1]杭州师范大学附属医院重症医学科,浙江杭州310015 [2]杭州师范大学附属医院呼吸科,浙江杭州310015

出　　处：《中华医院感染学杂志》2013年第17期4122-4124,共3页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金(Y2111111)

摘　　要：目的探讨强化静脉液体管理对重症肺部感染患者心肺功能的影响性,以提高心肺功能。方法随机选取2011年1月-2013年1月在医院治疗的56例重症肺部感染患者为研究对象,随机分成两组,对照组予以常规的营养支持治疗,观察组予以强化液体管理治疗;两组均以脉搏指示连续心输出量监测指导液体调整,均予以肺部CT检查,测定血浆B型脑利钠肽、白介素-6和灌洗液白蛋白/血浆白蛋白的水平以及肺部炎症的改变,比较两组以上指标的差异性。结果两组患者治疗前胸腔内血容量指数、血管外肺水指数、白介素-6、灌洗液白蛋白/血浆白蛋白、血浆B型脑利钠肽等水平比较,差异无统计学意义,而治疗后两组与治疗前比较差异均有统计学意义(P<0.05),治疗后强化液体管理组比对照组差异性更加明显(P<0.05),两组的胸部影像学变化也有明显的差异性(P<0.05)。结论强化液体管理可通过降低炎症反应和毛细血管的通透性,最终达到保护重症肺部感染患者心肺功能的目的。OBJECTIVE To study the influence of intensive fluid management on the cardiopulmonary function ofthe patients with severe pulmonary infections and enhance the cardiopulmonary functions. METHODS 56 cases ofpatients with severe pulmonary infection enrolled from Jan 2011 to Jan 2013 in our hospital were randomly selectedand divided into two groups. The control group was given conventional nutrition support therapy, and the obser-vation group was given therapy of intensive fluid management. The liquid adjustment of the two groups was moni-tored according to the pulse contour cardiac output （PiCCO）. The indicators such as lung CT inspection, BNP,IL-6 and lavage fluid albumin/plasma albumin levels and change of lung inflammation of the two groups were compared. RESULTS The CO, CI, ITBVI, EVLWI,IL-6, lavage albumin/plasma albumin, plasma BNP levels of patients in the two groups before treatment were of no significant difference. After the treatment, there was significant difference in these indicators between the two groups comparing with those before treatment （P〈0. 05） andmore significant difference in the intensive fluid management group after treatment as compared with those in thecontrol group （P〈0.05）. there was also significant difference in the chest imaging change of the patients betweenthe two groups （P〈C 0. 05）. CONCLUSION The intensive fluid management can protect the cardiopulmonary functions of the patients with severe pulmonary infection through reducing inflammation and capillary permeability.

关 键 词：强化液体管理 重症肺部感染 心肺功能 临床效果 

分 类 号：R563[医药卫生—呼吸系统]