血管外肺水在鉴别心源性和非心源性呼吸困难的临床价值

The Clinical Value of EVLW in Diagnosing Cardiac Dyspnea from Non-cardiac Dyspnes

目的通过对心源性和非心源性呼吸困难患者血管外肺水的比较,探讨血管外肺水在鉴别心源性和非心源性呼吸困难时的临床价值。方法对21例呼吸困难的患者根据临床症状及中心静脉压(CVP)值将患者分为二组:心源性呼吸困难组(Ⅰ)和非心源性呼吸困难组(Ⅱ)。入住ICU24h内行PiCCO监测,获取心输出量(CO)、心脏指数(CI)、中心静脉压(CVP)、血管外肺水(EVLW)、胸腔内血容量(ITBV)、全心舒张末期容量(GEDV)等参数。比较二组间EVLW的差异。结果1.二组患者年龄、性别、APACHEⅡ评分、血白蛋白浓度无显著差异;2.CO、CI,Ⅰ组显著低于Ⅱ组;3.CVP、EVLW、ITBV、GEDV,Ⅰ组显著高于Ⅱ组;4.Ⅰ组EVLW增加与CVP升高呈正相关,与年龄、APACHEⅡ评分、血白蛋白浓度、CO、CI、GEDV均无关。结论心源性呼吸困难患者EVLW增加与CVP升高呈正相关,与血浆白蛋白(Alb)浓度无显著相关性,表明心源性肺水肿是一种高压性水肿;EVLW可以用于鉴别肺水肿类型,用于鉴别心源性呼吸困难和非心源性呼吸困难。

Objective We explored the clinical value of EVLW to diagnose cardiac dyspnea from non-cardiac dyspnes, through comparing EVLW in patients with cardiac dyspnea and those in patients with non-cardiac dyspnes. Methods According to the clinical symptoms and CVP, 21 patients with dyspnea were divided into two groups： cardiac dyspnesg group （ Ⅰ group） and non-cardiac group （Ⅱ group）. When all patients were hospitalized in ICU, CO,CI, CVP, EVLW, ITBV and GEDV were gotten by PICCO in the first 24 hours. Then the difference of EVLW between two groups was analyzed. Results 1. There had no differences in age, gender, ALb and score of APHCHE Ⅱ between two groups. 2. CO and CI in patients with cardiac dyspnea were significantly lower than in patients with non-cardiac dyspnea. 3. CVP, EVLW, ITBV, and GEDV in Ⅰ group were significantly higher than in Ⅱ group. 4. The level of EVLW positively correlated with CVP in I group,but did not correlate with age, ALb, score of APHCHE Ⅱ , CO, CI and GEDV. Conclusion 1. Patients with cardiac dyspnea had significantly high level of EVLW. 2. There had positively correspond between the level of EVLW and CVP in patients with cardiac dyspnea, no correspend between the level of EVLW and Alb, so it was concluded that cardiac pulmonary edema is high pressure edema,EVLW may be used to diagnose cardiac dyspnea from non-cardiac dyspnea and the type of the pulmonary edema.