血管外肺水及肺血管通透性监测对ARDS救治的临床价值

Clinical value of extravascular lung water and pulmonary vascular permeability monitoring in treatment of ARDS

目的探讨通过监测血管外肺水(EVLW)指数及肺血管通透性指数(PVPI)反映急性呼吸窘迫综合征(ARDS)患者早期肺水肿严重程度的可行性及其指导治疗的价值。方法以58例急性呼吸衰竭行机械通气患者为研究对象,行脉波指示剂连续心排血量(Pi CCO)监测,计算PVPI,确定阳性者,并参考中华医学会呼吸病学分会制定的金标准诊断ARDS,评价PVPI检测敏感度等指标;行血气分析,测量动脉血氧分压(Pa O2),计算氧合指数,分析其与EVLW指数的相关性;对比ARDS患者中PVPI阳性者及EVLW指数阳性者与对应阴性者病死率。结果 PVPI阳性35例,其中ARDS患者28例;金标准检测ARDS阳性32例。PVPI诊断灵敏度87.5%,特异性73.1%。EVLW指数与氧合指数呈负相关(r=-0.41,P<0.01);EVLW指数≤14 ml/kg时,两者间无相关性;EVLW指数>14 ml/kg后,两者间呈负相关性(r=-0.51,P<0.01)。PVPI阳性者及EVLW指数阳性者病死率均显著性高于对应的阴性者(P<0.05)。结论 PVPI可反映肺毛细血管通透性,EVLW指数可反映氧合指数,监测这两个指标有助于监测ARDS的严重程度。

Objective To explore the clinical value of extravascular lung water （EVLW） and pulmonary vascular permeability index （PVPI） monitoring to reflect the severity of pulmonary edema in early stage in patients with acute respiratory distress syndrome （ARDS）. Methods Total 58 patients with acute respiratory failure to receive mechanical ventilation treatment were taken as research subjects. Pulse indicator continuous cardiac output （PiCCO） monitoring and calculation for PVPI were carried out to determine the positive ones; ARDS was diagnosed with reference to the gold standard of Chinese Medical Association （CMA）, and the indexes including PVPI detection sensitivity index were evaluated. In addition, blood gas analysis, artery partial pressure of oxygen （PaO2） were measured, and the oxygenation indexes were calculated in order to analyze its correlation with EVLW index; the case fatalities of PVPI and EVLW positive patients and those of the negative ones in ARDS patients were compared. Results The number of PVPI positive patients was 35, including 28 ARDS ones; the number of ARDS positive ones as detected in accordance with the gold standard was 32. PVPI diagnostic sensitivity was 87.5%, and specificity was 73.1%. EVLW index had was negatively correlated with oxygenation index （r =-0.41; P 〈 0.01）; when EVLW index was ≤14 ml/kg, there was no correlation between them; when EVLW index was 〉 14 ml/kg, there was a negative correlation between them （r =-0.51; P〈0.01）. Tile case fatalities of PVPI positive and EVLW positive ones were significantly higher than those in the corresponding negative ones （P 〈 0.05）, Conclusion PVPI can reflect the pulmonary capillary permeability, and EVLW index can reflect the oxygenation index; monitoring of the two indexes can help to monitor the severity of ARDS.