重症急性胰腺炎液体复苏时血管外肺水和胸腔积液变化:肺部超声研究  

Changes of extravascular lung water and pleural effusion by ultrasound during fluid resuscitation in patients with severe acute pancreatitis

作　　者：武钧[1] 钟鸣[1] 吴璟奕[1] 李梅玲[1] 张泓[1] 闵东[1] 李磊[1] 瞿洪平[1] 汤耀卿[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院重症医学科,上海200025

出　　处：《外科理论与实践》2015年第2期135-140,共6页Journal of Surgery Concepts & Practice

摘　　要：目的 :运用床边肺部超声检查监测并观察重症急性胰腺炎(SAP)病人液体复苏时血管外肺水(EVLW)变化特征及其对呼吸的影响。方法:收集2013年1月至2014年8月我科收治并行液体复苏治疗SAP病人的临床资料,回顾性分析实施床边肺部超声检查监测的23例病人肺部超声评分、血液动力学参数,研究液体复苏前、后EVLW变化特征及对呼吸的影响。结果 :液体复苏后SAP病人的循环参数[心率、平均动脉压、中心静脉压(CVP)、每小时尿量、动脉血乳酸和碱剩余]均明显改善(P<0.05),而氧合指数(Pa O2/Fi O2)明显下降、腹内压(IAP)明显增加(P<0.05)。复苏后肺部超声EVLW评分明显上升,EVLW增加以重力依赖区为主(P<0.05)。另外,双侧胸腔积液量也明显增加,以左侧增加更显著(P<0.05)。需机械通气者的液体复苏量、IAP、EVLW评分和胸腔积液量明显高于无需机械通气者(P<0.05)。EVLW评分与复苏液体量密切相关(相关系数为0.84,P<0.05),而与CVP、IAP及急性生理与慢性健康评估分数之间无相关性。结论:液体复苏可稳定SAP病人的循环状态,但增加EVLW、胸腔积液和IAP,从而影响肺氧合功能。肺部超声检查可作为SAP病人复苏治疗过程中EVLW变化的实时有效监测手段。Objective To investigate the changes of extravascular lung water（EVLW） measured by bedside lung ultrasound and the influence on respiration of the patients with severe acute pancreatitis（SAP） during fluid resuscitation.Methods A retrospective study was done in 23 patients with SAP admitted to our department from January 2013 to August 2014 with assessing EVLW by bedside lung ultrasound. The patients were treated with fluid resusucitation. Hemodynamic parameters and lung ultrasound parameters were collected before and after resuscitation. Results After fluid resuscitation,the hemodynamic parameters including heart rate, mean arterial pressure（MAP）, central venous pressure（CVP）, urine volume per hour, arterial blood lactic acid and base excess of the patients with SAP were significantly improved（ P0.05）, with oxygenation index（PaO2/FiO2） decreased and intra-abdominal pressure（IAP） increased（P0.05）. Lung water score especially in the gravity dependent region（P0.05）, and the amount of pleural effusion especially in the left pleural cavity（P0.05）increased significantly by lung ultrasound. The amount of fluid resuscitation, IAP, lung water score and pleural effusion in the patients required mechanical ventilation was higher than that of patients without the need of mechanical ventilation significantly（P0.05）. The lung water score was closely related to the amount of fluid resuscitation with correlation coefficient0. 84（ P〈0. 05）, but not with CVP, IAP and acute physiology and chronic health evaluation score. Conclusions Fluid resuscitation could stabilize the hemodynamics in the patients with SAP, which results in EVLW, pleural effusion and IAP and impairs oxygenation function. Lung ultrasound is suggested a tool for effective real-time monitoring of EVLW in the patients with SAP during fluid resuscitation.

关 键 词：肺部超声 血管外肺水 重症急性胰腺炎 液体复苏 

分 类 号：R657.51[医药卫生—外科学]