急性颅脑疾病患者血管外肺水指数的分布状况分析  

Clinical significance of extravascular lung water index in patients with acute cerebral disease in ICU

作　　者：王征[1,2] 贺春晖 骆勇[1] 贾文钗[1] 钟春妍[1] 张晓燕[1] Wang Zheng;He Chunhui;Luo Yong;Jia Wenchai;Zhong Chunyan;Zhang Xiaoyan(Department of Intensive Care Unit,Peking University Shougang Hospital,Beijing 100144,China;Department of Intensive Care Unit,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学首钢医院重症医学科,北京100144 [2]北京大学国际医院重症医学科,北京102206

出　　处：《中华临床医师杂志（电子版）》2021年第1期26-31,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京大学首钢医院科研基金项目(2012Y10)。

摘　　要：目的探讨急性颅脑疾病患者血管外肺水指数(EVLWI)的分布状况。方法本研究回顾性调查了2009年1月至2014年12月共71例由于急性颅脑疾病而收住北京大学首钢医院ICU的病历资料,对所有研究对象于发病6 h内置入连续心输出量(PICCO)装置监测血流动力学指标。收集研究对象年龄、性别、急性生理和慢性健康Ⅱ(APACHEⅡ)评分、格拉斯哥(GCS)评分、转归等一般资料,以及颅脑疾病类别、高血压病、冠心病、心功能不全等临床诊断资料;应用PULSION PICCO plus容量监测仪测定EVLWI。根据患者28 d转归情况分为死亡组和存活组。分析急性颅脑疾病患者在发病早期EVLWI水平分布情况。结果死亡组和存活组GCS评分存在显著性差异(P=0.02)。两组发病后EVLWI水平分析显示,发病后第3天和第5天EVLWI水平有显著性差异(P=0.024、0.010),死亡组均高于存活组;同时发病后第5天和第7天2组EVLWI升高比例也有显著性差异(P=0.047、0.028),死亡组高于存活组。对EVLWI分布与发病时间的相关性分析显示,所有患者发病后EVLWI和EVLWI升高比例均与发病天数呈正相关关系(r=0.14,P=0.005;r=0.991,P=0.000),死亡组EVLWI与发病天数亦呈正相关关系(r=0.337,P=0.000),而生存组的EVLWI与发病天数无相关性(r=0.039,P=0.587);存活组和死亡组的EVLWI升高比例与发病天数均呈正相关关系(r=0.862、0.938,P=0.013、0.001)。进一步对所有患者进行生存分析显示,第5天和第7天的EVLWI对患者的生存率有影响(P=0.038、0.011),EVLWI升高患者生存率明显降低。结论急性颅脑疾病发病后,EVLWI与病程及28 d存活率相关。Objective To investigate the clinical significance of extravascular lung water index(EVLWI)in patients with acute cerebral disease in ICU.Methods This study retrospectively investigated the medical records of 71 patients with acute cerebral disease in ICU of Peking University Shougang Hospital from January 2009 to December 2014.All the patients underwent PICCO catheter placement to monitor hemodynamic parameters within six hours.The general information including age,sex,APACHE II score,Glasgow score,and outcome was collected.The clinical diagnostic data such as the type of cerebral disease,hypertension,coronary heart disease,and heart failure were also collected.EVLWI was measured with a PULSION PICCO plus monitor.All patients were divided into either a death group or a survival group according to 28-day outcome and EVLWI was compared between the two groups.Results There was a significant difference in Glasgow score between the two groups(P=0.02).There was a higher EVLWI in the death group on the 3rd and 5th day after the onset of the disease(P=0.024 and 0.010,respectively),and the death group also had a higher percentage of patients with EVLWI elevation on the 5th and 7th day(P=0.047 and 0.028,respectively).Correlation analysis showed that EVLWI and the percentage of patients with EVLWI elevation were positively correlated with the number of days of onset(r=0.14,P=0.005;r=0.991,P=0.000),and EVLWI was also positively correlated with the number of days of onset in the death group(r=0.337,P=0.000),but not in the survival group(r=0.039,P=0.587).In both groups,the proportion of patients with increased EVLWI was positively correlated with the number of days of onset(r=0.862,P=0.013;r=0.938,P=0.001).Further survival analysis showed that on the 5th and 7th day,EVLWI had an effect on the survival rate of the patients(P=0.038 and 0.011),and the survival rate of the patients with increased EVLWI was decreased significantly.Conclusion After the onset of acute craniocerebral disease,EVLWI is related to the course of disease

关 键 词：急性颅脑疾病 血管外肺水指数 神经源性肺水肿 

分 类 号：R742[医药卫生—神经病学与精神病学]