血管外肺水在慢性阻塞性肺疾病急性加重期患者液体管理中的意义  

Significance of extravascular lung water in fluid management for patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：於江泉[1] 郑瑞强[1] 林华[1] 卢年芳[1] 邵俊[1] 王大新[2] 

机构地区：[1]江苏省苏北人民医院重症医学科,扬州225001 [2]江苏省苏北人民医院心内科,扬州225001

出　　处：《中华全科医师杂志》2015年第4期278-281,共4页Chinese Journal of General Practitioners

基　　金：扬州市医学重点后备人才项目资助（201328）

摘　　要：目的 探讨血管外肺水（ELWI）在慢性阻塞性肺疾病急性加重期患者液体管理中的指导价值,为慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者的液体管理提供临床策略.方法 2010年10月-2013年4月,选择江苏省苏北人民医院重症医学科符合慢性阻塞性肺疾病急性发作合并呼吸衰竭的患者63例,应用脉搏指示下连续心输出量技术监测患者胸腔内血容积指数（ITBI）和ELWI,比较ELWI与氧合指数、ITBI与ELWI之间的相关性,采用简单相关分析法进行统计学分析.结果 ELWI与氧合指数呈明显负相关（r=-0.741,P＜0.01）.进一步以ELWI=14 ml/kg进行分层分析,当ELWI＜ 14 ml/kg时,两者仍呈负相关（r=-0.524,P=0.080）,但差异无统计学意义;当ELWI≥14 ml/kg时,两者呈明显负相关（r=-0.952,P＜0.01）.ELWI与ITBI无明显相关性（r=0.477,P=0.072）.进一步以ITBI=1 000 ml/m^2做分层分析,当ITBI＜1 000 ml/m^2时,两者无明显相关性（r =0.332,P=0.117）,ITBI≥1 000 ml/m^2时,两者呈明显正相关（r =0.677,P＜0.01）.结论 过多的血管外肺水是导致慢性阻塞性肺病急性发作患者并发呼吸衰竭的重要因素.Objective To explore the correlations of extravascular lung water index （ELWI）,oxygenation index and intrathoracic blood volume index （ITBI） in patients with acute exacerbation chronicobstructive pulmonary disease （AECOPD） and examine the significance of ELWI in fluid management.Methods A total of 63 hospitalized AECOPD patients with respiratory failure were recruited from our hospital from October 2010 to April 2013.Pulse indicator continuous cardiac output （PiCCO） technology was employed to monitor ITBI and ELWI.We compared the relationship of ELWI,ITBI and oxygenation index.And simple correlation analysis was used for statistical processing.Results Significant negative correlation existed in ELWI and oxygenation index （r =-0.741,P 〈 0.01）.ELWI 14 ml/kg was defined as a cutoff value for subgroup analysis.A negative correlation existed between ELWI and oxygenation index in the subgroup with ELWI 〈 14 ml/kg,but there was no significant difference （r =-0.524,P =0.080） ; in the subgroup with ELWI ≥ 14 ml/kg,there was significant negative correlation （r =-0.952,P 〈 0.01）.No significant correlation existed between ELWI and ITBI （r =0.477,P =0.072）.ITBI 1 000 ml/m^2 was defined as a cutoff value for subgroup analysis.No significant difference existed in the subgroup with ITBI 〈 1 000 ml/m^2 （r =0.332,P =0.117）.However,significant positive correlation existed in the subgroup with ITBI≥ 1 000 ml/m^2 （r =0.677,P 〈 0.01）.Conclusion Excessive extravascular lung water is an important factor for acute exacerbation of COPD leading to respiratory failure.

关 键 词：血管外肺水 肺疾病 慢性阻塞性 液体管理 

分 类 号：R563.9[医药卫生—呼吸系统]