肺血管通透性指数对急性肺水肿鉴别诊断价值初探

The dinical application of pulmonary vascular permeability index on differential diagnosis of acute pulmonary edema

目的探讨肺血管通透性指数（PVPI）在急性肺水肿鉴别诊断中的价值。方法选2004年5月至2008年9月收住东南大学附属中大医院重症医学科，留置脉搏指示连续心排血量（PiCCO）导管，氧合指数[PaO：／吸入氧浓度（FiO2）]〈300mmHg（1mmHg=0．133kPa）且血管外肺水指数（EVLWI）≥7ml／kg的急性肺水肿患者，分为急性肺损伤（Au）组和心源性肺水肿组，观察PVPI、胸腔内血容量指数（ITBVI）、肺血容量（PBV）、血管外肺水（EVLW）／胸腔内血容量（ITBV）在2组中的变化与差异。结果（1）34例患者纳入研究，其中ALI22例，心源性肺水肿12例；（2）Au组PVPI为2．7±1．4，心源性肺水肿组为1．9±0．6，2组比较，P〈0．05。EVLWI、ITBVI在2组间差异无统计学意义（P〉0．05）；（3）PVPI与EVLWI呈正相关（r=0．762，P=0．000），与PaO2／FiO2呈负相关（r=-0．478，P=0．012）；（4）纳入患者中肺内原因ARDS8例，肺外原因ARDS5例，肺外原因ARDS患者PVPI、EVLW／ITBV和EVLWI显著高于肺内原因ARDS患者。结论PVPI有助于对重症患者肺水肿类型的鉴别。

Objective To assess the value of pulmonary vascular permeability index in differentiating acute lung injury（ALI） from cardiac pulmonary edema. Methods Critically ill patients with acute pulmonary edema were included from May, 2004 to September, 2008. Patients were divided into two groups, the ALI group and the cardiac pulmonary edema group （C group）. Pulmonary vascular permeability index （PVPI）, intrathoraeie blood volume （ITBVI） were determined by pulse indicator continuous cardiac output（PiCCO） system. Results （1）Thirty-four patients were enrolled, 22 cases in ALI group and 12 cases in C group. （2） The PVPI in patients of ALI group （ 2. 7± 1.4） was higher than that of C group （ 1.9 ± 0. 6 ; P 〈 0. 05 ）. EVLWI and ITBVI did not have the significant difference between the two groups （ P 〉 0. 05 ）. （ 3 ） PVPI was positively correlated with EVLWI（ r = 0. 762 ）, negatively correlated with PaO2/ FiO2 （ r = - 0. 478 ）. （ 4 ） ARDS was diagnosed in 13 cases, including 8 pulmonary cause （ARDSp） and 5 extra-pulmonary cause （ ARDSexp ） . PVPI, EVLW/ITBV and EVLWI of patients with ARDSexp were obviously higher than those with ARDSp. Conclusions PVPI may be useful for differentiating the types of pulmonary edema in the critically ill.