血管外肺水指数在老年脓毒症早期液体复苏中的应用

Prognostic value of extravascular lung water index in the elderly patients with sepsis

目的探讨血管外肺水指数(EVLWI)在老年脓毒症患者早期液体复苏治疗中的应用价值。方法根据脉搏波指示连续心排血量(PiCCO)技术测定的数据,将39例早期目标性治疗达标的老年严重脓毒症患者分为低EVLWI组(EVLWI≤7 ml/kg)和高EVLWI组(EVLWI>7 ml/kg)。比较两组患者在早期液体复苏治疗前及治疗后的血流动力学参数水平及乳酸水平;比较两组患者的28 d生存率;比较两组患者早期液体复苏后第3天APACHE II评分、ICU住院时间、机械通气应用时间、需要血液净化治疗的急性肾衰竭的发生率。结果早期液体复苏达标后,与低EVLWI组比较,高EVLWI组(EVLWI>7%)老年脓毒症患者的ICU住院时间、机械通气时间、复苏后乳酸水平及第3天APACHE II评分均明显增高,且差异均有统计学意义(t分别=2.26、2.19、3.31、2.11,P均<0.05),但两组的28 d生存率比较,差异无统计意义(χ2=1.08,P>0.05)。结论在老年脓毒症患者早期液体复苏过程中,EVLWI过高将导致明显的危害,应当动态监测EVLWI。

Objective To analyze the prognostic value of extravascular lung water index（EVLWI） in the elderly patients with sepsis. Methods Thirty nine 39 elderly septic patients （〉60 years） in ICU were analyzed. All these patients were hemodynamieally monitored by PICCO and divided into two groups according to the level of EVLW1 after they had undergone EGDT： higher EVLWI term group and lower EVLWI term group. Then, the hemodynamieal monitoring, the level of lactate, the third-day Apache II score, 28-day survival, the use of CRRT,the duration in the ICU and in the hospital were recorded and compared. Results Compared with the higher EVLWI team, the duration of in the ICU and the days of using ventilation were statistically shortened, and the level of lactate and third-day Apache II score were lower in the lower EVLWI group （t=2.26, 2.19, 3.31, 2.11, P〈0.05 ）. But the two groups 28 days survival rate showed no statistical significance （χ2= 1.08, P〉0.05）. Conclusions EVLWI is a valuable predictor of prognosis in the elderly patients with sepsis.