休克合并急性呼吸窘迫综合征患者血管外肺水及中心静脉血氧饱和度与液体管理指标的关系  

Relationship between extravascular lung water,central venous oxygen saturation and fluid management indexes in patients with shock and ARDS

作　　者：蔡毅峰[1] 陈科署 陈佳炜[1] 蔡文阳[1] CAI Yi-feng;CHEN Ke-shu;CHEN Jia-wei(Department of Respiratory Medicine, Chaozhou Center Hospital Intensive Med- icine, 57~aozhou Guangdong 521021, China.)

机构地区：[1]潮州市中心医院重症医学科呼吸内科,广东潮州521021

出　　处：《临床和实验医学杂志》2018年第10期1054-1058,共5页Journal of Clinical and Experimental Medicine

基　　金：潮州市科技计划项目(编号:2015GY25)

摘　　要：目的分析血管外肺水(EVLW)及动态中心静脉血氧饱和度(ScvO_2)与休克合并急性呼吸窘迫综合征(ARDS)患者氧合指数、胸腔内血容量指数(ITBVI)的相关性。方法前瞻性纳入2013年9月至2016年12月接受治疗的休克合并ARDS患者15例为对象,于治疗早期(0~2 d)持续检测计算患者血管外肺水指数(EVLWI)、ScvO_2、氧合指数、ITBVI,分析指标之间相关性。结果共搜集数据101组。EVLWI、ITBVI、氧合指数均不随时间变化而发生明显变化(P>0.05);ScvO_2随时间的延续显著增加(P<0.05)。EVLWI与氧合指数呈明显负相关(P<0.05),进一步分组,当EVLWI>15 ml/kg时,两者呈明显负相关(P<0.05),当EVLWI≤15 ml/kg时,两者未见明显相关性(P>0.05)。EVLWI与ITBVI无明显相关性(P>0.05),进一步分组,当ITBVI≤1 100 ml/m2时,两者无明显相关性(P>0.05),当ITBVI>1 100 ml/m2时,两者呈明显正相关(P<0.05)。ScvO_2>70%时,EVLWI、ITBVI明显更低,氧合指数明显更高,差异有统计学意义(P<0.05)。结论 ScvO_2、EVLW在治疗早期均与休克合并ARDS患者液体管理疗效指标有关,检测ScvO_2、EVLW可能有助于指导开展液体管理。Objective To investigate the relationship between extravascular lung water,（ EVLW）,central venous oxygen saturation（ ScvO_2） and oxygenation index,intrathoracic blood volume index（ ITBVI） in patients with shock combined with acute respiratory distress syndrome（ ARDS） treated with fluid management. Methods 15 patients with shock combined with ARDS hospitalized during September 2013 to December2016 were enrolled. Their EVLWI,ScvO_2,oxygenation index and ITBVI were continuous detected and analyzed at early treatment（ 0 ~ 2 days）.Results 101 groups of data were collected. EVLWI,ITBVI or oxygenation index did not change along with the change of time（ P〈0. 05）. ScvO_2 significant increased during treatment（ P〈0. 05）. EVLWI were negatively correlated with oxygenation index（ P〈0. 05）. After further grouping,when EVLWI 15 ml/kg,it showed a significant negative correlation with oxygenation index（ P〈0. 05）,when the EVLWI≤15 ml/kg,there is no significant correlation between them（ P〈0. 05）. There was no correlation between EVLWI and ITBVI（ P〈0. 05）. After further grouping,when ITBVI≤1 100 ml/m^2,there was no correlation between them（ P〈0. 05）,when ITBVI 1 100 ml/m2,there was significant positive correlation between them（ P〈0. 05）. When ScvO_2 70%,EVLWI and ITBVI were significantly lower,oxygenation index was significantly higher,the differences were statistically significant（ P〈0. 05）. Conclusion ScvO_2 and EVLW are related with the effect of fluid management in patients with shock combined with ARDS at early treatment,to detect these indicators may help guide treatment.

关 键 词：急性呼吸窘迫综合征 休克 血管外肺水 中心静脉血氧饱和度 液体管理 

分 类 号：R459.7[医药卫生—急诊医学]