脓毒症休克患者血管外肺水的监测及其对预后的预测价值

Monitoring on extravascniar lung water in patients with septic shock and its prognostic value

目的分析脓毒症休克患者血管外肺水（EVLW）的变化特点，探讨其与脓毒症休克预后的关系。方法采用回顾性分析的方法，将2l例脓毒症休克患者根据最终临床转归分为存活组（10例）与死亡组（11例），观察两组患者的临床特征，利用脉波指示剂连续心排血量（PiCCO）监护仪进行血流动力学监测，测定EVLW，分析其与患者预后的关系。结果存活组人院第1、2、3天EVLW分别为（12．7±1．8）、（11．3±1.3）、（10．1±1.3）ml／kg，死亡组分别为（14．4±1．0）、（14．6±1.4）、（14．6±1.3）ml／kg，两组比较差异有统计学意义（P〈0.05）；存活组随入院时间延长EVLW均明显下降（P〈0．05），死亡组无明显变化（p〉0．05）。结论脓毒症休克患者EVLW均有明显增加；EVLW的动态变化可预测患者的预后。

Objective To analyze the alterative characteristics of the extravascular lung water （EVLW） in the patients with septic shock and clarify its value on the prognosis of these patients. Methods By the methods of retrospective analysis, according to the ultimate survival, 21 patients with septic shock were divided into survivor group （ 10 cases） and non-survivor group （ 11 cases）. The clinical features of the patients were observed and hemodynamic monitoring was made with PiCCO monitor. The EVLW was measured and the relationship between the EVLW and the prognosis of patients was analyzed. Results On the first, second and third day, EVLW was （12,7 ± 1.8）, （11.3 ± 1.3）, （10.1 ± 1.3） ml/kg in survivor group, and （ 14.4 ± 1.0）, （ 14.6 ± 1.4）, （ 14.6 ± 1.3） ml/kg in non-survivor group respectively, and there were statistical differences between two groups （P 〈 0.05 ）. However, on the second day after the intensive therapy, EVLW in survivor group dropped significantly（P 〈 0.05 ）, but the non-survivor group only declined slightly, and compared with the result of the first day, there was no obvious difference （P 〉0.05）. Conclusions The EVLW in the patients with septic Shock increases significantly. The dynamic changes of the EVLW may be one of the factors for predicting the prognosis of patients with septic shock.