ARDS血管外肺水与不同血容量指标相关性的实验研究

An Experimental Study of Correlation Between Extravascular Lung Water and Blood Volume Indices in Acute Respiratory Distress Syndrome

【目的】探讨不同血容量指标与急性呼吸窘迫综合征(ARDS)血管外肺水(EVLWI)的相关性。【方法】利用内毒素(LPS)静脉注射复制绵羊ARDS模型,依次快速补充林格液1 000 ml/h,连续3 h,分别记录建模时(0 h)、快速补液1、23、h不同容量状态下血流动力学指标、氧合指数、胸腔内血容量(ITBVI)、心脏舒张末期容积(GEDVI),以及EVLWI的变化,并观察不同容量指标与EVLWI的相关性。【结果】心率(HR)、平均动脉压(MAP)各组间无明显差异。与建模时比较,输液后1 h心排出量(CI)明显升高,3 h后仍高于建模时。肺动脉嵌顿压(PAWP)在23、h高于0 h,中心静脉压(CVP)I、TBVI、GEDVI无显著升高。PAWP和CVP与CI的相关系数分别为0.009和0.133,显著低于ITBVI和GEDVI与CI的相关性(相关系数0.375和0.377)。PAWP和CVP与EVLWI的相关系数分别为0.411和0.257,显著低于ITBVI和GEDVI与EVLWI的相关性(相关系数0.722和0.722)。【结论】ITBVI和GEDVI是反映ARDS容量状态及EVLWI的较好指标,优于临床常用的PAWP及CVP。

[Objective]To study the correlation between extravascular lung water and blood volume indices in sheep with acute respiratory distress syndrome（ARDS）. [Methods]ARDS of fourteen sheeps was induced by lipopolysaccharides. Each sheep received Ringer＇s solution（1000ml/h）. Hemodynamics, oxygen index, extravascular lung water lndex （EVLWI）, intrathoracic blood volume index （ ITBVI）, and total end-diastolic volume index （TEDVI） were measured at 0, 1, 2, 3h after fluid infusion. [Results]There were no significant differences in heart rate,mean arterial pressure, central venous pressure （CVP） ,ITBVI,GEDVI in all groups, Compared with basic values （0 h）, cardiac index （CI） increased markedly at 1, 2, 3h （ P 〈0.05）, pulmonary artery wedge pressure （PAWP） increased significantly at 2, 3 h （ P 〈0.05）. TEDVI and ITBVI were significantly correlated with EVLWI （ r = 0. 722 respectively） , but not with PAWP （ r =0. 257）. TEDVI and ITBVI were significantly correlated with CI （ r = 0. 375 and 0. 377, respectively）, but not with CVP and PAWP （ r =0. 133 and 0. 009, respectively）. [Conclusion]TEDVI and ITBVI are more useful indicators than CVP and PAWP for assessment of EVLWI and volume monitoring in ARDS.