EVLWI在ARDS患者液体管理中的指导意义及对预后的评估价值

The value of prognosis and guidance of EVLWI in fluid management in patients with ARDS

目的 探讨血管外肺水指数（EVLMI）对急性呼吸窘迫综合征（ARDS）患者液体管理的指导意义及对病情发展的预测价值.方法 回顾性分析本院重症监护病房（ICU）收治的45例ARDS患者的临床资料,根据患者预后情况分为死亡组13例及存活组32例,对比分析两组患者的临床特点及脉搏指数连续心输出量监测（PiCCO）情况.结果 死亡组急性生理学及慢性健康状况评分系统Ⅱ（APACHEⅡ）评分显著高于存活组,差异有统计学意义（P＜0.05）.存活组入住ICU后第1～3d平均动脉压（MAP）、氧合指数（PaO2/FiO2）、心输出量（CO）逐渐上升,而血乳酸水平及EVL-MI水平逐渐下降,组间差异有统计学意义（均P＜0.05）.经Pearson相关因素分析可知,EVLMI与MAP、PaO2/FiO2、CO呈负相关（均P＜0.05）,与APACHEⅡ评分、血乳酸水平呈正相关（均P＜0.05）,而与CVP无相关性（P＞0.05）.结论 EVLMI可作为ARDS患者血管通透性变化的评价指标,可动态评价ARDS患者预后情况.

Objective To investigate the fluid management guidance and its predictive value of extravascular lung water index （EVLMI） for acute respiratory distress syndrome （ARDS） in patients with patients with disease progres sion. Methods 45 patients with ARDS hospital intensive care unit （ICU） were divided into death group （n=13） and sur vival group （n=32）. The clinical characteristics and pulsatility index continuous monitoring of cardiac output （PiCCO） of two groups were compared. Results The acute physiology and chronic death group health evaluation Ⅱ （APACHE Ⅱ） score of death group were higher than survival group （P〈0. 05）. The mean arterial pressure （MAP）, oxygenation index （PaO2/FiO2）, cardiac output （CO） gradually increased, and blood lactate levels and decreased levels EVLMI, statistical comparison of survival group were increased after ICU admission from 1~3d. The blood lactate levels and decreased lev els EVLMI,statistical comparison between groups Learn the difference （P〈0. 05）. The EVLMI with MAP, PaO2/ FiO2, CO was negatively correlated （all P〈0. 05）, and APACHE If score, blood lactate levels were positively correlated （all P〈0.05）, whereas no correlation with CVP （P〉0.05）. Conclusion EVLMI as vascular permeability changes in ARDS evaluation index dynamically evaluate the prognosis of patients with ARDS.