血管外肺水指数与氧合指数评估急性肺损伤程度准确性的比较

Extravascular lung water index versus oxygenation index in estimation of severity of acute lung injury

目的比较血管外肺水指数（EVLWI）与氧合指数（PaO2／FiO2）评估急性肺损伤（Au）程度的准确性。方法创伤后（创伤时间〈48h）Au行机械通气患者16例，性别不限，年龄18-80岁，采用PiCCO监测仪监测EVLWI，建立PiCCO监测后每隔24h采集动脉血样，测定PaO2，计算PaO2／FiO2；同时记录EVLWI，并进行肺损伤评分（LIS）。分别在建立PiCCO监测后24、48、72h时按PaO2／FiO2将患者分为PaO2／FiO2≤300组（200mmHg〈PaO2／FiO2≤300nunHg）和PaO2／FiO2≤200组（PaO2／FiO2≤200mmHg），按EVLWI将患者分为EVLWI〈10组（EVLWI〈10ml／ks）和EVLWI≥10组（EVLWI≥10ml／kg）。结果与PaO2，FiO2≤300组比较，PaO2／FiO2≤200组建立PiCCO监测后24、48h时LIS评分差异无统计学意义（P〉0．05），建立PiCCO监测后72h时LIS评分升高（P〈0．01）。与EV—LWI〈10组比较，EVLWI≥10组各时点LIS评分均升高（P〈0．05或0．01）。结论 临床中PaO2／FiO2作为评估ALI程度的指标存在局限性，而EVLWI在评估ALI程度方面可能比PaO2／FiO2更准确。

Objective To compare extravascular lung water index （EVLWI） and oxygenation index （PaO2/FiO2 ） in estimation of acute lung injury （ALI）. Methods Sixteen patients with post traumatic ALI （within 48 h） of both sexes, aged 18-80 yr, were studied. The patients were mechanically ventilated. Right internal jugular vein and femoral artery were catheterized and connected to PiCCO monitor （IntelliVue MPS0, Philips, Netherlands）. EVLWI was monitored with the PiCCO system. PaO2 was determined every 24 h. ALI was diagnosed based on the following criteria： （1） PaO2/FiO2 ≤ 300 mm Hg; （2） X-ray chest film-patchy shadows in the bilateral lungs and （3） CVP≤ 12 mm Hg. Lung injury score （LIS） was recorded. The patients were divided into PaO2/FiO2 ≤ 300 group and ≤ 200 group and EVLWI ≥ 10 group and 〈 10 group. Results There was no significant difference in LIS between PaO2/FiO2 ≤300 group and PaO2/FiO2 ≤200 group at 24 and 48 h of PiCCO monitonng. At 72 h of PiCCO monitoring LIS was significantly increased in PaO2/FiO2 ≤ 200 group as compared with PaO2/FiO2 ≤ 300 group. LIS was significantly higher in EVLWI≥ 10 group than in EVLWI 〈 10 group at 24, 48 and 72 h of PiCCO monitoring. Conclusion EVLWI is more accurate than PaO2/FiO2 in estimation of severity of ALI.