血管外肺水指数在心脏术后急性呼吸窘迫综合征早期识别中的意义  

Extravascular lung water index predicts early stage acute respiratory distress syndrome in patients after cardiac surgery with cardiopulmonary bypass

作　　者：王永杰[1] 邬志强[1] 张海涛[1] 贡旭楠[1] 陈阳[1] 张靓靓[1] 

机构地区：[1]吉林省人民医院重症医学科,吉林省长春市130021

出　　处：《中国心血管病研究》2015年第2期173-176,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨血管外肺水在体外循环心肺转流（CPB）下心脏术后急性呼吸窘迫综合征（ARDS）早期识别中的意义.方法 选取2011年2月至2014年2月我院CPB下心脏术后且存在ARDS高危因素的30例患者进行前瞻性研究,入ICU后连续2d监测血管外肺水指数（EVLWI）、氧合指数（PaO2/FiO2）、肺血管通透性指数（PVPI）.结果 进展为ARDS的患者术后第1天的EVLWI明显高于未进展为ARDS的患者[（15.9±7.6）ml/kg比（8.6±2.2）ml/kg,P=0.04].以术后第1天血管外肺水指数＞10.06 ml/kg（理想体重）为截点,预测ARDS的敏感度为83.3％,特异度为80.0％,阳性预计值为89.47％,阴性预计值为72.72％.与入组时即诊断ARDS患者比较,存在危险因素并进展为ARDS的患者入室后第1天的EVLWI无明显差别[（14.6±4.8）ml/kg比（15.9±7.6）ml/kg,P=0.97].结论 血管外肺水指数升高是ARDS的早期特征性表现,在达到柏林标准之前2.6 d即明显升高,可作为CPB下心脏术后存在高危因素患者是否进展为ARDS的早期预警指标,进而争取有利治疗时机,改善预后.Objective To determine the predictive value of extravascular lung water index in patients at risk after cardiac surgery with cardiopulmonary bypass for development of acute respiratory distress syndrome （ARDS）. Methods Extravascular lung water index, PaO2/FiO2, and other markers of disease severity were mea- sured prospectively in 30 patients after cardiac surgery with cardiopulmonary bypass for 2 days after admission to the intensive care unit. Results The mean extravascular lung water index on day 1 for patients who progressed to ARDS was higher than for those who did not [ （15.9±7.6）ml/kg vs （8.6±2.2）ml/kg, P=0.04 ]. An extravascular lung water index cutoff value on day 1 of 10.06 ml/kg had a 83.3% sensitivity, 80.0% specificity, positive predictive value of 89.47%, and negative predictive value of 72.72% to predict progression to ARDS. Conclusion Elevated extravascular lung water index is a feature of early stage acute respiratory distress syndrome and predicts progression to ARDS in patients with risk factors.

关 键 词：心肺转流 急性呼吸窘迫综合征 血管外肺水指数 氧合指数 

分 类 号：R563.8[医药卫生—呼吸系统]