血管外肺水指数对感染性休克合并肺毛细血管渗漏的老年患者预后的评估价值  

Value of extravascular lung water Index in assessment of prognosis of elderly patients with combined septic shock and pulmonary capillary leakage

作　　者：吴晓燕[1] 庄志清[1] 郑瑞强[1] 林华[1] 

机构地区：[1]江苏省苏北人民医院重症医学科,扬州225001

出　　处：《中华老年医学杂志》2015年第3期278-282,共5页Chinese Journal of Geriatrics

摘　　要：目的 评估血管外肺水指数（EVLWI）与感染性休克合并肺毛细血管渗漏老年患者预后的关系. 方法 选择2011年1月到2012年12月入住苏北人民医院重症医学科34例感染性休克合并肺毛细血管渗漏老年患者,应用脉波指示剂连续心输出量（PiCCO）技术监测3d,监测心脏指数、全心舒张末期容积指数（GEDI）、体循环阻力指数（SVRI）、肺血管通透指数（PVPI）以及EVLWI,根据患者实际体质量（ABW）和理想体质量（PBW）,分别计算实际EVLWI和理想EVLWI;监测气道峰压、平台压、平均气道压（Pm）、潮气量、呼气末正压（PEEP）、吸氧浓度（FiO_2）,计算肺静态顺应性（Cst）;用血气分析测定动脉血氧分压（PaO_2）、并计算PaO_2/FiO_2、氧合指数（OI）.胸部X线片检查,行肺损伤评分.分别比较实际血管外肺水指数（EVLWIa）和理想血管外肺水指数（EVLWIp）与PaO_2/FiO_2、Cst以及肺损伤评分的相关性,并评估其对感染性休克合并肺毛细血管渗漏老年患者预后的预测价值. 结果 共34例患者纳入本研究,入组第1天死亡组序贯器官衰竭评分（SOFA）、乳酸高于存活组.入组第3天死亡组SOFA、肺损伤、PVPI、乳酸、液体平衡、去甲肾上腺素剂量、EVLWIa、EVLWIp均高于存活组（P＜0.05）,PaO_2/FiO_2低于存活组（P＜0.05）.EVLWIa、EVLWIp与肺损伤评分（r分别为0.461、0.588,P＜0.05）呈正相关,与PaO2/FiO2（r值分别为-0.307、-0.386,P＜0.05）呈负相关;EVLWIa、EVLWIp与Cst呈负相关,但差异无统计学意义（r值分别为-0.141、-0.154,均P＞0.05）.应用Logistic多元回归分析,SOFA、EVLWIa、EVLWIp是感染性休克合并肺毛细血管渗漏老年患者死亡的危险因素.通过应用受试者工作特征（ROC）曲线评价入组时SOFA、EVLWIa、EVLWIp对预后评估的价值,结果显示ROC曲线下面积（AUC）分别为0.769、0.832、0.855.以EVLWIp=11.96 ml/kg为折点,预测患者存活的灵敏度为94.4％Objective To investigate the value of extravascular lung water index（EVLWI） in assessment of prognosis of elderly patients with combined septic shock and pulmonary capillary leakage.Methods Totally 34 elderly patients with septic shock and pulmonary capillary leakage in our hospital from Jan.2011 to Dec.2012 were selected.Cardiac index （CI）,global end diastolic volume index （GEDI）,systemic vascular resistance index （SVRI）,pulmonary vascular permeability index （PVPI） and EVLWI were detected by pulse-indicator continuous cardiac output （PiCCO） technology for 3 days.Based on the actual body weight （ABW） and predicted body weight （PBW）,the actual extravascular lung water index and predicted extravascular lung water index were calculated.Peak airway pressure （Ppeak）,plateau pressure （Pplat）,mean airway pressure （Pm）,tidal volume （VT）,positive end expiratory pressure （PEEP）,oxygen concentration （FiO2） and static lung compliance （Cst） were monitored,the arterial partial pressure of oxygen （PaO2） was detected by blood gas analysis,and the PaO2/FiO2 （P/F） and oxygenation index （OI） were calculated.Chest X-ray,lung injury score （LIS） were conducted.The correlations of EVLWI to actual body weight （EVLWIa） and predicted body weight（EVLWIp） with P/F,Cst and LIS were analyzed.The predictive value of EVLWIa and EVLWIp in the prognosis in elderly patients with septic shock and pulmonary capillary leakage was assessed.Results At day 1,non-survivors had higher levels of SOFA score and lactate level than survivors （both P〈0.05）.However,these variables including SOFA score,LIS,PVPI,lactate level,fluid balance,norepinephrine level,EVLWIa and EVLWIp were higher and PaO2/FiO2 was lower in non-survivors than in the survivors at day 3 （all P〈0.05）.EVLWIa and EVLWIp were positively correlated with LIS （r=0.461 and 0.588,both P〈0.05） and negatively correlated with PaO2/FiO2 （P/F） （r=-0.307 and-0.436,both P〈0.05）.EVLWIa and EVLWIp

关 键 词：血管外肺水 感染 休克 预后 毛细血管渗漏综合征 

分 类 号：R459.7[医药卫生—急诊医学]