神经源性肺水肿患者血管外肺水变化的临床意义  

Clinical significance of changes of extravascular lung water in patients with neurogenic pulmonary edema

作　　者：江家树[1] 汤展宏[1] 张驰[1] 

机构地区：[1]广西医科大学第一附属医院重症医学科,南宁530021

出　　处：《中国循证心血管医学杂志》2016年第3期308-310,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：卫生部国家临床重点建设专科项目基金(2011-873)

摘　　要：目的 探讨神经源性肺水肿（NPE）患者血管外肺水（EVLW）变化的临床意义。评估血管外肺水指数（EVLWI）对NPE患者预后判断的意义。方法 选择2010年1月~2013年3月广西医科大学第一附属医院重症医学科NPE患者42例,男性28例,女性14例,年龄26~69岁,平均年龄（43.2±10.5）岁。采用脉搏指示连续心输出量（PICCO）监测EVLWI、肺血管通透性指数（PVPI）,比较治疗前后EVLWI、PVPI与氧合指数（OI）的差异,分析EVLWI、PVPI、OI之间的相关性。根据患者结局分为存活组与死亡组,比较两组治疗前与治疗7 d后EVLWI差异。结果 与治疗前对比,治疗第3 d、第5 d、第7 d EVLWI明显下降（P〈0.05）、PVPI明显下降（P〈0.05）,同时期OI显著升高（P〈0.05）;EVLWI和PVPI分别与OI存在显著负相关（r=-0.509,P〈0.05;r=-0.541,P〈0.001）;EVLWI和PVPI呈正相关（r=0.712,P〈0.01）。存活组与死亡组患者治疗前EVLWI水平无统计学差异（9.4±3.1 vs.10.1±2.7,P〉0.05）;治疗7 d后,存活组患者EVLWI较治疗前显著下降（6.2±2.0 vs.9.4±3.1,P〈0.01）,亦低于死亡组（6.2±2.0 vs.8.4±1.7,P〈0.05）。结论 EVLW的高低能直接反映NPE患者的疾病严重程度,EVLW越高,则病情越重,OI越低;同时监测EVLWI能预测病死率。Objective To investigate the clinical significance of changes of extravascular lung water （EVLW） in patients with nenrogenic pulmonary edema （NPE）, and review the prognosis meaning of EVLW index （EVLWI） to NPE patients. Methods NPE patients （n=42） were chosen from Jan. 2010 to Mar. 2013.The changes of EVLWI and pulmonary vascular permeability index （PVPI） were detected by using pulse indicator continuous cardiac output （PICCO）, and difference in EVLWI, PVPI and oxygenation index （OI） were compared before amt after treatment. The correlation among EVLWI, PVPI and OI was analyzed. The patients were divided, according to their outcomes, into survival group and death group, and the difference in EVLWI was compared between 2 groups before and 7 d after treatment. Results EVLWI decreased significantly （P〈0.05）, PVPI decreased significantly （P〈0.05） and OI increased significantly （P〈0.05） in 2 groups after treatment for 3 d, 5 d and 7 d. EVLWI and PVPI were, respectively, correlated negatively to OI （r=-0.509, P〈0.05; r=-0.541, P〈0.001）. EVLWI was correlated positively to PVPI （r=0.712, P〈0.01）. EVLWI had no statistical difference between survival group and death group before treatment （9.4± 3.1 vs. 10.1 ±2.7, P〉0.05）. After treatment for 7 d, EVLWI decreased significantly in survival group （6.2 ± 2.0 vs. 9.4± 3.1, P〈0.01）, which was lower than that in death group （6.2 ±2.0 vs. 8.4 ± 1.7, P〈0.05）. Conclusion The level of EVLW can directly reflect the severity of disease in NPE patients. The higher EVLW was, the more severe the disease was and the lower the OI was. At the same time EVLWI can predict mortality.

关 键 词：神经源性肺水肿 血管外肺水 肺血管通透性指数 氧合指数 

分 类 号：R563[医药卫生—呼吸系统]