血管外肺水指数与肺血管通透性指数及胸腔内血容量指数对烧伤后肺水肿鉴别诊断的意义  

Significance of extravascular lung water index, pulmonary vascular permeability index, and in- trathoracic blood volume index in the differential diagnosis of burn-induced pulmonary edema

作　　者：李磊[1] 盛嘉隽 王光毅[1] 吕开阳[1] 秦晶[2] 刘功成[1] 马兵[1] 肖仕初[1] 朱世辉[1] 

机构地区：[1]第二军医大学长海医院烧伤外科、全军烧伤研究所,上海200433 [2]第二军医大学长海医院急诊手术室,上海200433

出　　处：《中华烧伤杂志》2015年第3期186-191,共6页Chinese Journal of Burns

基　　金：国家自然科学基金（30730091）;上海市科技人才计划（10XD1405600、12QA1404400）;长海医院“1255”学科建设计划（CH125510207、CH125510208、CH125510212）

摘　　要：目的评价血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）、胸腔内血容量指数（ITBVI）对严重烧伤后肺水肿类型鉴别诊断的意义。方法2011年12月-2014年9月，笔者单位烧伤科ICU收治38例接受机械通气及脉搏轮廓心排血量监测、伤后1周内并发肺水肿的严重烧伤患者，对其临床资料进行回顾性分析。将患者根据肺水肿类型分为肺损伤型组17例和静水压型组21例，比较2组患者EVLWI、PVPI、ITBVI、氧合指数、肺损伤评分，分析前4个指标之间的相关性，前3个指标与肺水肿类型的相关性。对数据行t检验、X2检验、Mann—WhitneyU检验、Pearson相关分析及准确性检验[受试者工作特征（ROC）曲线分析方法]。结果肺损伤型组患者EVLWI与静水压型组相近。分别为（12．9±3．1）、（12．1±32．1）mL／kg，U=159．5，P〉0．05。肺损伤型组患者PVPI为2．6±0．5、肺损伤评分为（2．1±0．6）分，明显高于静水压型组的1．4±0．3、（1．0±0．6）分，u值分别为4．5、36．5，P值均小于0．01。肺损伤型组患者ITBVI、氧合指数分别为（911±197）mL／m2、（136±69）mmHg（1mmHg=0．133kPa），低于静水压型组的（1305±168）mL／m2、（2124-60）mmHg，U值分别为21．5、70．5，P值均小于0．01。肺损伤型组患者EVLWI与PVPI、ITBVI均呈明显正相关（r值分别为0．553、0．807，P〈0．05或P〈0．01）；氧合指数与EVLWI、PVPI均呈明显负相关（r值分别为-0．674、-0．817，P值均小于0．01）。静水压型组患者EVLWI与ITBVI呈明显正相关（r=0．751，P〈0．01），与PVPI无明显相关性（r=-0．275，P〉0．05）；氧合指数与EVLWI、PVPI均无明显相关性（r值分别为0．197、0．062，P值均大于0．05）。PVPI值对烧伤后肺水肿类型鉴别诊断的ROC曲线下总面积为0．987（95％置信区间为0．962—1．013，P〈0．01），PVPI最佳阈值为1．9时，其敏感度为94．1％Objective To appraise the significance of extravascular lung water index （ EVLWI ） , pulmonary vascular permeability index （PVPI） , and intrathoraeic blood volume index （ITBVI） in the differ- ential diagnosis of the type of burn-induced pulmonary edema. Methods The clinical data of 38 patients, with severe burn hospitalized in our burn ICU from December 2011 to September 2014 suffering from the complication of pulmonary edema within one week post burn and treated with mechanical ventilation accom-panied by pulse contour cardiac output monitoring, were retrospectively analyzed. The patients were divided into lung injury group （L, n = 17） and hydrostatic group （H, n = 21 ） according to the diagnosis of pulmo- nary edema. EVLWI, PVPI, ITBVI, oxygenation index, and lung injury score （L/S） were compared be- tween two groups, and the correlations among the former four indexes and the correlations between each of the former three indexes and types of pulmonary edema were analyzed. Data were processed with t test, chi- square test, Mann-Whitney U test, Pearson correlation test, and accuracy test [ receiver operating character- istic （ROC） curve ]. Results There was no statistically significant difference in EVLWI between group L and group H, respectively （12.9 ±3.1） and （12.1 ±2.1） mL/kg, U =159.5, P 〉0.05. The PVPI and LIS of patients in group L were respectively 2.6 ± 0.5 and （2.1 ± 0.6） points, and they were significantly higher than those in group H [ 1.4 ± 0.3 and （ 1.0 ± 0.6） points, with U values respectively 4.5 and 36.5, P values below 0.01 ]. The ITBVI and oxygenation index of patients in group L were respectively （911 ± 197） mL/m2 and （136 ± 69） mmHg （1 mmHg = 0. 133 kPa） , which were significantly lower than those in group H [ （ 1 305 ± 168） mL/m2 and （212 ± 60） mmHg, with U values respectively 21.5 and 70.5, P values below 0.01 ]. In group L, there was obviously positive correlation between EVLWI and PVPI, or EVLWI and ITBVI （ with

关 键 词：烧伤 肺水肿 血管外肺水 肺血管通透性 脉搏轮廓心排血量 

分 类 号：R644[医药卫生—外科学]