血管外肺水指数和胸腔内血容积指数在脓毒性休克合并ARDS患者液体管理中的应用  

Extravascular Lung Water Index and Intrathoracic Blood Volume Index as Indicators of Sepsis Shock Patients with Acute Respiratory Distress Ayndrome

作　　者：陈佳炜[1] 蔡毅峰[1] 

机构地区：[1]广东省潮州市中心医院,广东潮州521000

出　　处：《中国医学创新》2017年第2期67-70,共4页Medical Innovation of China

基　　金：潮州市科技计划项目(2015GY25)

摘　　要：目的:研究血管外肺水指数(EVLWI)和胸腔内血容积指数(ITBVI)在脓毒性休克合并急性呼吸窘迫综合征(ARDS)患者液体管理中的临床应用。方法:选取入住潮州市中心医院重症医学科的50例脓毒性休克合并ARDS患者为研究对象,采用随机数字表法将所有患者分为对照组和观察组,每组25例。对照组以中心静脉压(CVP)指导液体管理,观察组患者应用PICCO监测,以EVLWI、ITBVI为指标指导液体管理。比较两组患者的早期目标导向性治疗(EGDT)的达标率,1、3 d时APACHEⅡ评分、SOFA评分、去甲肾上腺素用量、血清乳酸、呼吸参数、血肌酐、机械通气率、机械通气时间、住ICU时间及28 d病死率。结果:观察组6 h的EGDT达标率显著高于对照组患者(P<0.05),而两组24 h达标率比较差异无统计学意义(P>0.05)。观察组3 d时APACHEⅡ评分、SOFA评分、去甲肾上腺素用量、血清乳酸和呼吸参数显著改善(P<0.05),而对照组无显著改善(P>0.05)。观察组血肌酐1、3 d比较,差异均无统计学意义(P>0.05),而对照组血肌酐增加显著(P<0.05)。观察组机械通气率、机械通气时间、住ICU时间及28 d病死率均显著优于对照组(P<0.05)。结论:EVLWI和ITBVI在评价和指导脓毒性休克合并ARDS患者的液体管理中的应用效果显著,可降低患者机械通气率、通气时间、住ICU时间及28 d病死率,改善预后。Objective：To study the clinical application of extravascular lung water index（EVLWI） and intrathoracic blood volume index（ITBVI） as indicators of sepsis shock patients with acute respiratory distress ayndrome（ARDS）.Method：A total of 50 patients were divided into the control group and the observation group according to the random number table methods,25 cases in each group.The control group was givencentral venous pressure（CVP） for fluid management,while observation group was given PICCO hemodynamic for fluid management.The time and the rate in achieve EGDT target of two grouops were compared.APACHE Ⅱ,SOFA,noradrenaline dosage,serum lactic acid,respiratory parameters,serum creatinine,rate of mechanical ventilation,mechanical ventilation time,ICU stay time and 28-day mortality of two groups were compared 1 day and 3 days.Result：The ratio of achieving EGDT target in 6 hours of the observation group was significantly higher than that of the control group（P〈0.05）.The ratio of achieve EGDT target in 24 hours of two groups was not statistically different（P〈0.05）.APACHE Ⅱ,SOFA,noradrenaline dosage,serum lactic acid,respiratory parameters were significantly decreased 3 days after treatment in the observation group（P〈0.05）,but did not change significantly in the control group（P〈0.05）.Serum creatinine of the control group was significantly increased（P〈0.05）.The rate of mechanical ventilation,mechanical ventilation time,ICU stay time and 28-day mortality of the observation group were significantly better than those of the control group（P〈0.05）.Conclusion：Compared with CVP,ITBVI and EVLWI can more accurately assess and guide fluid management in severe pneumonia patients with septic shock with less duration o I mechanical ventilation ICU stay and mortality,and improve the prognosis.

关 键 词：脓毒性休克 急性呼吸窘迫综合征 血管外肺水指数 胸腔内血容积指数 液体管理 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]